Am J Psychiatry 1983; 140:212-214
Copyright © 1983 by American Psychiatric Association
The methylphenidate test for differentiating desipramine-responsive from nortriptyline-responsive depression
HC Sabelli, J Fawcett, JI Javaid and S Bagri
Monitoring tricyclic antidepressant concentrations in the plasma of 43
patients with major depressive disorders indicated that some responded to
imipramine or desipramine but not to amitriptyline or nortriptyline, or
vice versa, even though plasma levels were within therapeutic ranges. Mood
elevation by methylphenidate predicted marked improvement from treatment
with imipramine or desipramine but not with amitriptyline or nortriptyline.
When methylphenidate failed to improve mood, patients responded to
amitriptyline or nortriptyline but not to desipramine. These results
suggest differential drug responses with different tricyclic
antidepressants, the clinical utility of the methylphenidate test, and the
heterogeneity of depressions. The authors question the mechanism of action
of nortriptyline via blockade of norepinephrine reuptake.
