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

To manage a treatment resistant depression, clinicians may add a second medication to the firstantidepressant drug. the aim of the current research was to study the outcome of augmentation of citalopramwith nortryptiline or triiodothyronine in a randomized clinical trial.methods: we selected 48 adult outpatients with a diagnosis of non-psychotic major depressive disorder whohad not responded to 12 weeks citalopram therapy (40 mg per day). they were randomly allocated to twogroups. 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 ىg per day). the remission of depression was defined as a score of 7 or less on the 17-itemhamilton rating scale for depression (hrsd-17).results: after 8 weeks, the nortriptyline group had a higher remission rate (33.33 %) than thetriiodothyronine group (17.64%). the nortriptyline group, however, had a higher drop out rate due toexperiencing more side effects.conclusion: augmentation of citalopram with nortryptiline seems to be effective in the management oftreatment resistant depression. however, one should strike a balance between the efficacy and the tolerability ofthis approach, as there is a higher chance of experiencing side effects by the patients.iranian journal of psychiatry and behavioral sciences (ijpbs) , volume 1, number 2, autumn and winter 2007 : 23-27 .