Differential effect of amitriptyline and bupropion on primary and secondary depression: a pilot study

In a prospective, controlled, double-blind study, 37 patients with major depressive disorder were subclassified into primary depression (N = 25) and secondary (N = 12) depression and treated with either amitriptyline (primary depressives N = 13, secondary depressives N = 6) or bupropion (primary depressives N = 12, secondary depressives N = 6). A differential response to the novel antidepressant bupropion was observed between the two diagnostic subgroups, but no differential response to amitriptyline was observed; patients with primary depression and secondary depression responded equally well to amitriptyline but not to bupropion. Our results provide pharmacological evidence supporting the usefulness of this subclassification of depression.