Comparing the efficacy of add-on nortryptiline with triiodothyronine in the management of citalopram-resistant depression

ABSTRACT

To manage a treatment resistant depression, clinicians may add a second medication to the first antidepressant drug. The aim of the current research was to study the outcome of augmentation of citalopram with nortryptiline or triiodothyronine in a randomized clinical trial. We selected 48 adult outpatients with a diagnosis of non-psychotic major depressive disorder who had not responded to 12 weeks citalopram therapy [40 mg per day]. They were randomly allocated to two groups. One group received nortryiptiline [at a dose of up to 150 mg per day] and the other triiodothyronine [T3] [at a dose of up to 50 micro g per day]. The remission of depression was defined as a score of 7 or less on the 17-item Hamilton Rating Scale for Depression [HRSD-17]. After 8 weeks, the nortriptyline group had a higher remission rate [33.33%] than the triiodothyronine group [17.64%]. The nortriptyline group, however, had a higher drop out rate due to experiencing more side effects. Augmentation of citalopram with nortryptiline seems to be effective in the management of treatment resistant depression. However, one should strike a balance between the efficacy and the tolerability of this approach, as there is a higher chance of experiencing side effects by the patients