Comparing the Efficacy of add-on Nortryptiline With Triiodothyronine in the Management of Citalopram-Resistant Depression

Objective: 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. Methods: 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 μg 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). Results: 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 dropout rate due to experiencing more side effects. Conclusion: 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.