Abstract
Twenty-five patients with depression seen in private psychiatric practice in Manhattan were given nortriptyline to determine
1) Whether the drug was active.
2) What the approximate dosage should be.
3) How long a course of treatment was required.
4) When dosage should be changed.
5) What type of patient was most likely to respond.
6) What side effects were likely to occur.
Sixty per cent of the patients showed initial improvement but twelve per cent relapsed and in one case the improvement was slight. Thirty-two per cent however gave a favourable and apparently lasting response which is significant since most of these patients had previously been treated with other medications unsuccessfully. Of the total group about a quarter of the patients complained of intolerable side effects so that medication was discontinued, although with two exceptions this was at the option of the patient rather than the therapist. All of the patients who responded favourably had manifested moderate to mild anxiety in addition to depression. Side effects were relatively mild and particularly so in respect to hypotension, which is the most common difficult side effect in the use of antidepressants. In two cases reversible psychotic reactions developed which led to discontinuance of the drug in one case and the addition of phenothiazines in the other.
Seven of the patients were referred for psychological testing which included Wechsler-Bellevue Digit Span and Digit Symbol Sub-Test; Rotter Sentence Completion; MMPI; Rorschach; TAT; Figure Drawings and Stories; and Bender-Gestalt Figures A, 4 and 8. Six of the patients returned for retesting after one to three months of drug therapy. Based on psychological test data alone, four of the six showed signs of improvement although no single quantitative or qualitative change in test pattern was found.