OBJECTIVE: The authors examined the rate of response to the combination
of nortriptyline and interpersonal psychotherapy for acute and continuation
treatment of elderly patients with recurrent major depression. METHOD: The
subjects were 73 elderly patients, 61 of whom completed treatment.
Nortriptyline steady-state blood levels were maintained at 80-120 ng/ml,
and interpersonal psychotherapy was administered weekly for 9.1 weeks
(medium) of acute therapy and was decreased from biweekly to triweekly
during 16 weeks of continuation therapy. During acute treatment
nonresponding patients also received brief adjunctive pharmacotherapy with
lithium or perphenazine. RESULTS: Of the 61 subjects given adequate trials
of nortriptyline and interpersonal psychotherapy, 48 (78.7%) achieved full
remission (Hamilton depression rating of 10 or lower over 16 weeks of
continuation therapy), 10 patients (16.4%) did not respond (Hamilton rating
never below 15), and three achieved only partial remission (Hamilton rating
of 11-14). Early versus late onset was not associated with a difference in
response rate. During the placebo-controlled, double-blind transition to
maintenance therapy, 19 (76.0%) of the 25 patients randomly assigned to
placebo maintenance conditions showed continued recovery and six relapsed.
None of the 24 patients assigned to nortriptyline conditions relapsed.
CONCLUSIONS: Use of nortriptyline plus interpersonal psychotherapy for 9.1
weeks (median) of acute and 16 weeks of continuation therapy appears to be
associated with good response and relatively low attrition but about a 25%
chance of relapse during double-blind discontinuation of nortriptyline.
These data require confirmation in a controlled clinical trial of acute and