title: Psychiatric comorbidity as a predictor of clinical response to nortriptyline in treatment-resistant major depressive disorder.
abstract: BACKGROUND
  A number of studies of major depressive disorder suggest that psychiatric co-morbidity may contribute to treatment resistance. The purpose of this study was to test whether the presence of comorbid Axis I and Axis II disorders predicts clinical response to an open trial of nor-triptyline among patients with treatment-resistant depression.
  
  
  METHODS
  Ninety-two outpatients with treatment-resistant DSM-III-R major depressive disorder were enrolled in a 6-week open trial of nor-triptyline (Nov. 1992-Jan. 1999). The presence of comorbid Axis I and Axis II disorders was established at baseline with the use of the Structured Clinical Interview for DSM-III-R. Chi-square analyses were used to test Axis I or Axis II co-morbid conditions as a predictor of clinical response to nortriptyline.
  
  
  RESULTS
  Thirty-nine patients (42.4%) responded to nortriptyline. The presence of avoidant personality disorder (p <.01) predicted poorer response to nortriptyline. The response rate was 16.7% for patients with and 48.6% for patients without comorbid avoidant personality disorder. No other comorbid diagnoses were found to predict clinical response in a statistically significant manner.
  
  
  CONCLUSIONS
  The presence of avoidant personality disorder conferred a poorer prognosis in treatment-resistant depression patients treated with nortriptyline.
authors.affiliation: Depression Clinical and Research Program, Massachusetts General Hospital, Harvard Medical School, Boston, Mass 02114, USA. gpapakostas@partners.org
authors.forename: George I
authors.initials: GI
authors.lastname: Papakostas
authors.forename: Timothy J
authors.initials: TJ
authors.lastname: Petersen
authors.forename: Amy H
authors.initials: AH
authors.lastname: Farabaugh
authors.forename: Jessica L
authors.initials: JL
authors.lastname: Murakami
authors.forename: Joel A
authors.initials: JA
authors.lastname: Pava
authors.forename: Jonathan E
authors.initials: JE
authors.lastname: Alpert
authors.forename: Maurizio
authors.initials: M
authors.lastname: Fava
authors.forename: Andrew A
authors.initials: AA
authors.lastname: Nierenberg
mesh_terms: D000293:Adolescent; D000328:Adult; D000368:Aged; D000929:Antidepressive Agents, Tricyclic / Q000494:pharmacology / Q000627:therapeutic use*; D015897:Comorbidity; D003866:Depressive Disorder / Q000150:complications / Q000188:drug therapy* / Q000523:psychology*; D004351:Drug Resistance; D005260:Female; D006801:Humans; D008297:Male; D008875:Middle Aged; D009661:Nortriptyline / Q000494:pharmacology / Q000627:therapeutic use*; D010554:Personality Disorders / Q000150:complications*; D011379:Prognosis; D012307:Risk Factors; D016896:Treatment Outcome
chemical_list: D000929:Antidepressive Agents, Tricyclic; D009661:Nortriptyline