title: Acute open-trial nortriptyline therapy of bereavement-related depression in late life.
abstract: BACKGROUND
  The aim of this study was to generate preliminary data on the clinical efficacy of nortriptyline in bereavement-related depression in late life.
  
  
  METHODS
  Data are presented on 13 patients (5 men, 8 women), ranging in age from 61 to 78 years (mean = 71.1). Mean time from spousal loss to the beginning of treatment was 11.9 months (range 2-25). Subjects were required to meet Research Diagnostic Criteria for syndromal current major depression and to have a stable Hamilton Rating Scale for Depression (HAM-D) score of greater than or equal to 15. Ten of the 13 volunteers were experiencing their first lifetime episode of major depression. Patients were treated with nortriptyline (mean dose = 49.2 mg/day; mean steady-state level = 68.1 ng/mL). Ratings performed at base-line and weekly during therapy were used to assess symptomatology, intensity of grief, level of functioning, social support, physical impairment, and medication side effects.
  
  
  RESULTS
  Pretreatment HAM-D ratings average 22.1 +/- 3.6; posttreatment, 7.2 +/- 2.8, representing a 67.9% decrease. All other rating scales showed significant clinical improvement, except the Texas Revised Inventory of Grief (a measure of grief intensity) (pretreatment, 51.4 +/- 7.3; posttreatment, 46.6 +/- 6.9, only a 9.3% decrease).
  
  
  CONCLUSIONS
  These results suggest that nortriptyline is associated with significant symptomatic improvement in all areas of bereavement-related depression except continued intensity of grief after a median treatment interval of 6.4 weeks. This study indicates the need for a controlled clinical trial to determine the placebo response rate, the relapse rate after discontinuation of medication, and the value of combination therapy (using both pharmacotherapy and psychotherapy).
authors.affiliation: Department of Psychiatry, University of Pittsburgh School of Medicine, Pa.
authors.forename: R E
authors.initials: RE
authors.lastname: Pasternak
authors.forename: C F
authors.initials: CF
authors.lastname: Reynolds
authors.forename: M
authors.initials: M
authors.lastname: Schlernitzauer
authors.forename: C C
authors.initials: CC
authors.lastname: Hoch
authors.forename: D J
authors.initials: DJ
authors.lastname: Buysse
authors.forename: P R
authors.initials: PR
authors.lastname: Houck
authors.forename: J M
authors.initials: JM
authors.lastname: Perel
mesh_terms: D000367:Age Factors; D000368:Aged; D003643:Death; D003866:Depressive Disorder / Q000188:drug therapy* / Q000523:psychology; D004334:Drug Administration Schedule; D005260:Female; D005500:Follow-Up Studies; D006117:Grief; D006801:Humans; D008016:Life Change Events; D008297:Male; D008393:Marriage / Q000523:psychology; D008875:Middle Aged; D009661:Nortriptyline / Q000008:administration & dosage / Q000097:blood / Q000627:therapeutic use*; D010555:Personality Inventory; D010865:Pilot Projects; D011569:Psychiatric Status Rating Scales; D012720:Severity of Illness Index
chemical_list: D009661:Nortriptyline