Acute open-trial nortriptyline therapy of bereavement-related depression in late life.
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).
Pasternak
R E
RE
Department of Psychiatry, University of Pittsburgh School of Medicine, Pa.
Reynolds
C F
CF
Schlernitzauer
M
M
Hoch
C C
CC
Buysse
D J
DJ
Houck
P R
PR
Perel
J M
JM
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
D009661:Nortriptyline