Tricyclic nonresponders: phenomenology and treatment

In an attempt to identify characteristics of tricyclic antidepressant nonresponders, the authors reviewed the records of inpatients with unipolar, nondelusional depression who had received adequate treatment (confirmed by plasma level determination) with tricyclics. The 17 patients who failed to respond were compared to a group of tricyclic responders with respect to demographic and phenomenologic variables. Although the nonresponders tended to have more previous episodes of depression and higher anxiety scores on the pretreatment Hamilton scale than the responders, they could not be distinguished from the responders by clinical or demographic data. All of the patients who failed to respond to tricyclics subsequently responded to monoamine oxidase inhibitors and/or ECT.