Topic
Nortriptyline
About: Nortriptyline is a research topic. Over the lifetime, 1435 publications have been published within this topic receiving 53776 citations. The topic is also known as: Aventyl® & nortriptyline hydrochloride.
Papers published on a yearly basis
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Papers
TL;DR: It is indicated that without active treatment, virtually all remitted patients relapse within 6 months of stopping ECT, and the combination of nortriptyline and lithium is more effective, but the relapse rate is still high, particularly during the first month of continuation therapy.
Abstract: ContextElectroconvulsive therapy (ECT) is highly effective for treatment of
major depression, but naturalistic studies show a high rate of relapse after
discontinuation of ECT.ObjectiveTo determine the efficacy of continuation pharmacotherapy with nortriptyline
hydrochloride or combination nortriptyline and lithium carbonate in preventing
post-ECT relapse.DesignRandomized, double-blind, placebo-controlled trial conducted from 1993
to 1998, stratified by medication resistance or presence of psychotic depression
in the index episode.SettingTwo university-based hospitals and 1 private psychiatric hospital.PatientsOf 290 patients with unipolar major depression recruited through clinical
referral who completed an open ECT treatment phase, 159 patients met remitter
criteria; 84 remitting patients were eligible and agreed to participate in
the continuation study.InterventionsPatients were randomly assigned to receive continuation treatment for
24 weeks with placebo (n = 29), nortriptyline (target steady-state level,
75-125 ng/mL) (n = 27), or combination nortriptyline and lithium (target steady-state
level, 0.5-0.9 mEq/L) (n = 28).Main Outcome MeasureRelapse of major depressive episode, compared among the 3 continuation
groups.ResultsNortriptyline-lithium combination therapy had a marked advantage in
time to relapse, superior to both placebo and nortriptyline alone. Over the
24-week trial, the relapse rate for placebo was 84% (95% confidence interval
[CI], 70%-99%); for nortriptyline, 60% (95% CI, 41%-79%); and for nortriptyline-lithium,
39% (95% CI, 19%-59%). All but 1 instance of relapse with nortriptyline-lithium
occurred within 5 weeks of ECT termination, while relapse continued throughout
treatment with placebo or nortriptyline alone. Medication-resistant patients,
female patients, and those with more severe depressive symptoms following
ECT had more rapid relapse.ConclusionsOur study indicates that without active treatment, virtually all remitted
patients relapse within 6 months of stopping ECT. Monotherapy with nortriptyline
has limited efficacy. The combination of nortriptyline and lithium is more
effective, but the relapse rate is still high, particularly during the first
month of continuation therapy.
691 citations
TL;DR: In geriatric patients with recurrent major depression, maintenance treatment with nortriptyline or IPT is superior to placebo in preventing or delaying recurrence and combined treatment using both appears to be the optimal clinical strategy in preserving recovery.
Abstract: ContextElderly patients with major depression are at high
risk for recurrence, increased mortality, and chronic disability.ObjectiveTo determine the efficacy of maintenance nortriptyline
hydrochloride and interpersonal psychotherapy (IPT) in preventing
recurrence of major depressive episodes in patients older than 59 years.DesignA 2×2 randomized, double-blind,
placebo-controlled clinical trial, stratified by therapist.SettingUniversity-based psychiatric research clinic.PatientsOf a total of 187 patients with recurrent nonpsychotic
unipolar major depression (average age, 67 years; one third aged ≥70
years) recruited through clinical referral and media announcements, 107
were fully recovered after open acute and treatment continuation with
nortriptyline and IPT. These patients were randomly assigned to 1 of 4
maintenance therapy conditions.InterventionsMonthly medication clinic with nortriptyline
hydrochloride (80-120 ng/mL steady-state levels)
(n=24); medication clinic with placebo
(n=29); monthly maintenance IPT with placebo
(n=21); and monthly maintenance IPT with nortriptyline
(n=22).Main Outcome MeasureRecurrence of major depressive episode.ResultsThe time to recurrence of a major depressive episode for
all 3 active treatments was significantly better than for placebo.
Recurrence rates over 3 years were as follows: nortriptyline and IPT,
20% (95% confidence interval [CI], 4%-36%); nortriptyline and
medication clinic visits, 43% (95% CI, 25%-61%); IPT and placebo,
64% (95% CI, 45%-83%); and placebo and medication clinic visits,
90% (95% CI, 79%-100%). Combined treatment with nortriptyline and
IPT was superior to IPT and placebo and showed a trend to superior
efficacy over nortriptyline monotherapy (Wald
χ2=3.56; P=.06).
Subjects aged 70 years and older had a higher and more rapid rate of
recurrence than those aged 60 to 69 years.ConclusionIn geriatric patients with recurrent major depression,
maintenance treatment with nortriptyline or IPT is superior to placebo
in preventing or delaying recurrence. Combined treatment using both
appears to be the optimal clinical strategy in preserving
recovery.
661 citations
Stanford University1, Leiden University Medical Center2, University of Michigan3, Centre for Addiction and Mental Health4, Dokkyo Medical University5, University of Minnesota6, Washington University in St. Louis7, Indiana University8, University of Missouri–Kansas City9, NorthShore University HealthSystem10, St. Jude Children's Research Hospital11, Federal Institute for Drugs and Medical Devices12
TL;DR: In this paper, an update to the 2012 Clinical Pharmacogenetics Implementation Consortium (CPIC) guideline for CYP2D6 and CYP 2C19 Genotypes and Dosing of Tricyclic Antidepressants is presented.
Abstract: CYP2D6 and CYP2C19 polymorphisms affect the exposure, efficacy and safety of tricyclic antidepressants (TCAs), with some drugs being affected by CYP2D6 only (e.g., nortriptyline and desipramine) and others by both polymorphic enzymes (e.g., amitriptyline, clomipramine, doxepin, imipramine, and trimipramine). Evidence is presented for CYP2D6 and CYP2C19 genotype-directed dosing of TCAs. This document is an update to the 2012 Clinical Pharmacogenetics Implementation Consortium (CPIC) guideline for CYP2D6 and CYP2C19 Genotypes and Dosing of Tricyclic Antidepressants.
573 citations
TL;DR: There was a significantly greater improvement in depression in patients treated with nortriptyline than in a similar group of placebo-treated patients, providing an important addition to the treatments available for stroke patients.
526 citations
TL;DR: Clomipramine, but not nortriptyline, was superior to placebo in interview-based ratings of severity of OCD, and the effect was not clear-cut until after five weeks of treatment.
Abstract: The effect of clomipramine hydrochloride in severe obsessive-compulsive disorder (OCD) was compared with that of nortriptyline hydrochloride and placebo in a five-week randomized, double-blind trial. Clomipramine, but not nortriptyline, was superior to placebo in interview-based ratings of severity of OCD. The effect was not clear-cut until after five weeks of treatment. When clomipramine was given openly to 22 patients after the end of the controlled trial, half of the patients responded to the drug. The response could not be predicted from severity or duration of illness, sex or age of the patient, or presence or absence of secondary depressive symptoms. The amelioration with clomipramine was not sustained if the drug was withdrawn.
523 citations
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Performance Metrics
| Year | Papers |
|---|---|
| 2025 | 16 |
| 2024 | 18 |
| 2023 | 31 |
| 2022 | 47 |
| 2021 | 16 |
| 2020 | 17 |