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 medicationto 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-psychoticmajor depressive disorder who had not responded to 12 weeks citalopram therapy (40 mg perday). they were randomly allocated to two groups. one group received nortryiptiline (at a dose of upto 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 7or 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 triiodothyroninegroup (17.64%). the nortriptyline group, however, had a higher dropout ratedue 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.