Nortriptyline in depression

Roose SR Laghrissi-Thode F, Kennedy IS, et al. Comparison of paroxetine and nortriptyline in depressed patients with ischemic heart disease. lAMA i998 279 287-29i. 

Roose SP, Glassman AH, Giardina EGV, et al. Nortriptyline in depressed patients with left ventricular impairment. JAMA 1986 256 3253-3257. 

JF Sayegh. A simplified radioimmunoassay of plasma nortriptyline in depressed patients compared with high pressure liquid chromatography and gas liquid chromatography. Neurochem Res 11 193, 1986. 

Bertilsson L, Aberg-Wistedt A, Liden A, Otani K, Spina E. Alprazolam does not inhibit the metabolism of nortriptyline in depressed patients or inhibit the metabolism of desipramine in human liver mierosomes. Ther DrugMonit (1988) 10,231-3. 

Vandel S, Bertschy G, Jounet JM, Allers G. Valpromide increases the plaana concentrations of amitriptyline and its metabolite nortriptyline in depressive patients. TherDrugMomt 9 Z) 10,386-9. 

Compared to antipsychotics, there are even fewer studies on the prescribing patterns of antidepressants done in Asian countries. Pi etal. (1985) conducted a survey of psychotropic prescribing practices reported by psychiatrists in 29 medical schools in 9 Asian countries. Daily dose range of tricyclic antidepressants (TCAs) such as amitriptyline, imipramine, and nortriptyline in Asian countries was comparable to the practice in USA. This is despite differences found between Asian and non-Asian populations in the pharmacokinetics of TCAs (Pi et al, 1993). A questionnaire on the practical prescribing approaches in mood disorders administered to 298 Japanese psychiatrists was reported by Oshima et al. (1999). As first-line treatment, the majority of respondents chose newer TCAs or non-TCAs for moderate depression and older TCAs for severe depression. Combination of antidepressants and anxiolytics was preferred in moderate depression, while an antidepressant and antipsychotic combination was common in severe psychotic depression. Surprisingly, sulpiride was the most favored drug for dysthymia. In a naturalistic, prospective follow-up of 95 patients with major depression in Japan, the proportion of patients receiving 125 mg/day or less of imipramine was 69% at one month and 67% at six months (Furukawa et al., 2000). 

B34. Burrows, G. D., Davies, B., and Scoggins, B. A., Plasma concentration of nortriptyline and clinical response in depressive illness. ImticH ii, 619-623 (1972). 

Fig. 9. Relationship between amelioration scores in depressed patients and steady-state plasma concentrations of the antidepressant nortriptyline. Both low and high concentrations are associated with minimum therapeutic effect. (From Asherg M, Cronholm B, Sjoqvist F, Tuck D. Relationship between plasma level and therapeutic effect of nortriptyline. Br Med J 1971 3 331-4, with permission from the BMJ Publishing Group.)...

K. White, J. Razani, B. Cadow, R. Gelfand, R. Palmer, G. Simpson, R.B. Sloane, Tranylcypromine vs. nortriptyline vs. placebo in depressed out patients A controlled trial, Psychopharmacology 82 (1984) 258-262. 

Geller, B., Cooper, T.B., and Chestnut, E.C. (1985a) Serial monitoring and achievement of steady state nortriptyline plasma levels in depressed children and adolescents preliminary data. / Clin Psychopharmacol 5 213—216. 

Sovner et al. (1998) have done an excellent job summarizing the data on antidepressants in patients with developmental disabilities. There have been nine reports of antidepressant use in adults with depression and MR and three reports of antidepressant use in children and adolescents. Eight of nine reports in adults were positive. The drugs studied included nialimide (n = 27), fluoxetine (9), imipramine (6), amoxapine (2), and nortriptyline (1) (total n = 45). In addition, Sovner et al. identified four reports of antidepressant use in children. One involved successful treatment with fluoxetine in an adolescent, another indicated efficacy with imipramine and amitriptyline in 9 of 12 children (Do-sen, 1982), and a third showed successful management in 3 of 4 children treated with imipramine or tryptophan plus nicotinamide (Dosen, 1990). One study of fluoxetine in depressed children with autism and MR witnessed improvement in depression but not in compulsive symptoms (Ghaziuddin and Tsai, 1991). 

Kupfer DJ, Spiker DG, Rossi A, et al Nortriptyline and EEG sleep in depressed patients. Biol Psychiatry 17 535-546, 1982a... 

Bondareff, W., Alpert, M., Friedhoff, A.J., et al Comparison of sertraline and nortriptyline in the treatment of major depressive disorder in late life. Am. J. Psychiatry 157, 729-736. 2000. 

Geller B, Cooper TB, Graham DL, et al. Pharmacokinetically designed double-blind placebo-controlled study of nortriptyline in 6 to 12 year-olds with major depressive disorder. J Am Acad Child Adolesc Psychiatry 1992 31 34-44. 

Using the same protocol as in the study of Dalen et al. in Caucasians (48), we investigated the influence of the Asian specific CYP2D6 10 allele on the disposition of nortriptyline in Chinese subjects living in Sweden (50). Morita et al. (51) related the CYP2D6 10 allele to steady-state plasma levels of nortriptyline and its metabolites in Japanese depressed patients. From these two studies it may be concluded that the Asian CYP2D6 10 allele... 

Reynolds, C.F. 3rd, Perel, J.M., Frank, E., Imber, S., and Kupfer, D.J. Open-trial maintenance nortriptyline in geriatric depression survival analysis and preliminary data on the use of REM latency as a predictor of recurrence. Psychopharmacol Bull 1989, 25 129-132. 

Borson S, McDonald GJ, Gayle T, et al. Improvement in mood, physical symptoms, and function with nortriptyline for depression in patients with chronic obstructive pulmonary disease. Psychosomatics 1992 33 190-201. 

To date, genotyping has been used solely to explain the between-subject variability in clearance with the genotype treated as any other covariate. Kvist et al. (2001) first studied the role CYP 2D6 genotype plays in the clearance of nortriptyline in 20 subjects with depression and 20 healthy volunteers. CYP 2D6 genotype can be classified into four groups based on the number of functional genes ... 

The dibenzapine derivatives are called tricyclic antidepressants and include imipramine (Tofranil), desipramine (Norpramin), amitriptyline (Elavil), nortriptyline (Aventyl), protriptyline (Vivactil), and doxepin (Adapin). Amitriptyline is indicated in depression major depression with melancholia or psychotic symptoms depressive phase of bipolar disorder depression associated with organic disease, alcoholism, schizophrenia, or mental retardation anorexia or bulimia associated with depression (see Figure 20). 

Solai LK, Mulsant BH, Pollock BG, Sweet RA Rosen J, Yu K, Reynolds CP. Effect of sertraline on plasma nortriptyline levels in depressed elderly. J Clin P chiatry (1997) 58,440-... 

Perry PJ, Browne JL, Prince RA, Alexander B, Tsuang MT. Effects of smoking on nortriptyline plasma concentrations in depressed patients. TherDrugMonit (1986) 8, 279-84. 

Reduced serum levels of amitriptyline and its metabolite, nortriptyline, were observed in depressed patients taking amitriptyline along with 900 mg St. John s wort daily for 12 to 14 days (Johne et al. 2002). 

Nortriptyline. Nortriptyhne, a tricychc antidepressant, has been shown in double-blind, placebo-controlled randomized trials to be superior to placebo for smoking cessation (Prochazka et al. 1998). Nortriptyline appears to have efficacy comparable to that of bupropion for smoking cessation (Hall et al. 2002). The efficacy of this agent may be improved with more intensive behavioral therapies (Hall et al. 1998). Nortriptyline s mechanism of action is thought to relate to its noradrenergic and serotonergic reuptake blockade, because these two neurotransmitters have been implicated in the neurobiology of nicotine dependence. Side effects of nortiptyline are typical of tricyclic antidepressants and include dry mouth, blurred vision, constipation, and orthostatic hypotension. Nortriptyline appears to have some utility for smokers with a past history of major depression, and it can be recommended as a second-... 

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