Nortriptyline for the Treatment of Anxiety and Depression in Chronically Ill and Geriatric Patients

Abstract

With the advent of amphetamine-type drugs and pentamethylenetetrazol (Metrazol) (1) there has been a continued search for new antidepressants. The mono-amine oxidase inhibitors such as etryptamine (Monase) (2), phenelzine (Nardil) and nialamide (Niamide) gave fairly good results, though adverse side effects were noted in many cases. Just a few years ago another effective antidepressant was introduced-imipramine (Tofranil) (3, 4). However, side effects also were noted when this drug was given in relatively high doses to geriatric patients.Recently, various avenues of research have led to the development of a new type of antidepressant at the National Institutes of Health [Brodie's group (5)]. This new drug is desmethylimipramine (D.M.I.), which is a mono-ethyl analogue of imipramine. Desmethylimipramine is far more rapid in its action, and more potent than imipramine.Meduna, Abood and Biel (6) followed with work on anticholinergic agents. Considerable interest was aroused recently by studies of other secondary amines which led to the investigation of nortriptyline (7) (Fig. 1). This drug has a definite sedative, tranquilizing and antidepressant effect. Its discovery should open up new paths in the search for a drug of therapeutic value in the management of chronically ill and/or geriatric patients who suffer from depression, anxiety, apathy and irritability.Our investigation centered exclusively on the use of nortriptyline (Aventyl)' in the chronically ill and geriatric patient. MATERIAL AND METHODSInitially, 65 patients suffering from various chronic illnesses associated with anxiety reactions, depression and other behavioral problems were selected for this study. Their ages ranged from 34 to 87 years, with an average of 59.8 years. There were 45 males and 20 females. The diagnoses were cerebral arteriosclerosis with or without chronic brain syndrome, generalized arteriosclerosis, multiple sclerosis and other spinal cord diseases, cerebrovascular accidents due to thrombosis or embolism, various cardiac diseases, chronic alcoholism and diabetes.

Labelling and drug effects in the treatment of neurotic affective disorders: an experimental investigation

“…It is reassuring that neurotic depressive conditions with overt anxiety have such an early response to nortriptyline alone. This confirms earlier reports (Chesrow et al 1964) and should mitigate against the use of tranquillizer-antidepressant combination therapies suggested by some workers for such conditions (Freeman et al 1974).…”

Depression in the Elderly: Pharmacologic Considerations in Treatment

“…The agents most commonly employed to treat depression are the tricyclic antidepressants and the newly available tetracyclic antidepressant, maprotiline. Although few controlled clinical studies of the tricyclic antidepressants have been performed in elderly populations, 17–20 these agents are widely used and are effective in appropriately selected older patients. Depressions characterized by sustained dysphoric mood or persistent loss of interest associated with the typical endogenous symptom pattern (gradual onset; prominent anhedonia; and disturbances of sleep, appetite, and psychomotor activity) are those most likely to respond to treatment with the tricyclic or tetracyclic antidepressants 21 …”

Clinical Aspects of Depression in a Home for the Aged

“…Higher dosages rapidly resulted in such problems as acute urinary retention or toxic brain syndrome. We and others have found that, in proper dosages, the tricyclic antidepressants are useful therapeutic adjuncts (6). For the treatment of manic reactions, phenothiazines were used effectively in about one‐third the usual dosage.…”