Psychiatric comorbidity as a predictor of clinical response to nortriptyline in treatment-resistant major depressive disorder.
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.
Papakostas
George I
GI
Depression Clinical and Research Program, Massachusetts General Hospital, Harvard Medical School, Boston, Mass 02114, USA. gpapakostas@partners.org
Petersen
Timothy J
TJ
Farabaugh
Amy H
AH
Murakami
Jessica L
JL
Pava
Joel A
JA
Alpert
Jonathan E
JE
Fava
Maurizio
M
Nierenberg
Andrew A
AA
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
D000929:Antidepressive Agents, Tricyclic; D009661:Nortriptyline