Skip to main content
Log in

Aspects of amitriptyline and nortriptyline plasma levels monitoring in depression

  • Original Investigations
  • Published:
Psychopharmacology Aims and scope Submit manuscript

Abstract

Fifty-nine depressed female inpatients were treated with 100 mg amitriptiline (AMT) IM for 4 weeks. Depression ratings and determinations of the parent drug and nortriptyline (NT) were performed weekly. No direct relationship between plasma AMT + NT concentrations and therapeutic response was apparent, but beneficial therapeutic responses and significantly lower side-effect scores were more frequently noted in subjects with concentrations in the 100–200 ng/ml range. AMT + NT concentrations were significantly correlated with age. No significant difference was found in the number of responders between younger and older subjects with two clinical improvement criteria; however, a significant difference emerged when a third more restrictive clinical outcome criterion was adopted. The implications of the present findings for patient treatment and for the interpretation of previous studies are discussed. The data collected point to a possible usefulness of monitoring AMT and NT plasma levels, even if further investigations are needed.

This is a preview of subscription content, log in via an institution to check access.

Access this article

Price excludes VAT (USA)
Tax calculation will be finalised during checkout.

Instant access to the full article PDF.

Similar content being viewed by others

References

  • Asberg M, Cronholm B, Sjöqvist F, Tuck D (1971) Relationship between plasma level and therapeutic effect of nortriptyline. Br Med J 3:331–334

    Google Scholar 

  • Baumann P, Jonzier-Perey M, Koeb L, Lê PK, Tinguely D, Schöpf J (1986) Amitriptyline pharmacokinetics and clinical response: I. Free and total plasma amitriptyline and nortriptyline. Int Clin Psychopharmacol 1:89–101

    Google Scholar 

  • Boyer WF, Lake CR (1987) Initial severity and diagnosis influence the relationship of tricyclic plasma levels to response: a statistical review. J Clin Psychopharmacol 7:67–71

    Google Scholar 

  • Braithwaite RA, Goulding R, Theano G, Bailey J, Coppen A (1972) Plasma concentration of amitriptyline and clinical response. Lancet I:1297–1300

    Google Scholar 

  • Breyer-Pfaff U, Gaertner HJ, Kreuter F, Scharek G, Brinkschulte M, Wiatr R (1982) Antidepressive effect and pharmacokinetics of amitriptyline with consideration of unbound drug and 10-hydroxynortriptyline plasma levels. Psychopharmacology 76:240–244

    Google Scholar 

  • Burch JE, Ahmed O, Hullin RP, Mindham RHS (1988) Antide-pressive effect of amitriptyline treatment with plasma drug levels controlled within three different ranges. Psychopharmacology 94:197–205

    Google Scholar 

  • Burrows GD, Davies B, Scoggins BA (1972) Plasma concentration of amitriptyline and clinical response in depressive illness. Lancet II:619–623

    Google Scholar 

  • Coppen A, Montgomery S, Ghose K, Rama Rao VA, Bailey J, Christiansen J, Mikkleson PL, Van Praag HM, Van de Poel F, Minsker EJ, Kozulja VG, Matussek N, Kungkunz G, Jørgensen A (1978) Amitriptyline plasma concentration and clinical effect. Lancet II:63–66

    Google Scholar 

  • Corona GL, Bonferoni B, Frattini P, Cucchi ML, Santagostino G (1983) Gas chromatographic routine analysis of five tricyclic antidepressants in plasma. J Chromatogr 277:347–351

    Google Scholar 

  • Corona GL, Cucchi ML, Frattini P, Santagostino G, Schinelli S, Comincioli V, Zerbi F, Fenoglio L, Savoldi F (1986) Amitripty-line and nortriptyline plasma levels, urinary 3-methoxy-4-hydroxyphenylglycol and clinical response in depressed women. Neuropsychobiology 16:97–102

    Google Scholar 

  • Hamilton M (1960) A rating scale for depression. J Neurol Neurosurg Psychiatry 23:56–62

    Google Scholar 

  • Kocsis JH, Hanin I, Bowden C, Brunswick D (1986) Imipramine and amitriptyline plasma concentrations and clinical response in major depression. Br J Psychiatry 148:52–57

    Google Scholar 

  • Liisberg P, Mose H, Amdisen A, Jørgensen A, Høpfner Petersen HE (1978) A clinical trial comparing sustained release amitriptyline (Saroten retard) and conventional amitriptyline tablets (Saroten) in endogenously depressed patients with simultaneous determination of serum levels of amitriptyline and nortriptyline. Acta Psychiatr Scand 57:426–435

    Google Scholar 

  • Lydiard RB (1985) Tricyclic-resistant depression: treatment resistance or inadequate treatment? J Clin Psychiatry 46:412–417

    Google Scholar 

  • Mendlewicz J, Linkowski P, Rees JA (1980) A double bind comparison of dothiepin and amitriptyline in patients with primary affective disorder: serum levels and clinical response. Br J Psychiatry 136:154–160

    Google Scholar 

  • Montgomery SA, McAuley R, Montgomery DB, Dawling S, Braitwaite RA (1980) Pharmacokinetics and efficacy of maprotiline and amitriptyline in endogenous depression: a double bind controlled trial. Clin Ther 3:292–310

    Google Scholar 

  • Perry PJ, Pfohl BM, Holstad SG (1987) The relationship between antidepressant response and tricyclic antidepressant plasma concentrations. A retrospective analysis of the literature using logistic repression analysis. Clin Pharmacokinet 13:381–392

    Google Scholar 

  • Plotkin DA, Gerson SC, Jarvik LF (1987) Antidepressant drug treatment in the elderly. In: Meltzer HY (ed) Psychopharmacology: the third generation of progress. Raven Press, New York

    Google Scholar 

  • Preskorn SH, Mac DS (1985) Plasma levels of amitriptyline: effect of age and sex. J Clin Psychiatry 46:276–277

    Google Scholar 

  • Quednow B, Walther H, Genz A, Kühne GE (1981) Amitriptyline levels and clinical effects. Aggressologie 22:15–18

    Google Scholar 

  • Rubin EH, Biggs JT, Preskorn SH (1985) Nortriptyline pharmacokinetics and plasma levels: implications for clinical practice. J Clin Psychiatry 46:418–424

    Google Scholar 

  • Ziegler VE, Clayton PJ, Biggs JT (1977) A comparison study of amitriptyline and nortriptyline with plasma levels. Arch Gen Psychiatry 34:607–612

    Google Scholar 

Download references

Author information

Authors and Affiliations

Authors

Rights and permissions

Reprints and permissions

About this article

Cite this article

Corona, G.L., Cucchi, M.L., Frattini, P. et al. Aspects of amitriptyline and nortriptyline plasma levels monitoring in depression. Psychopharmacology 100, 334–338 (1990). https://doi.org/10.1007/BF02244602

Download citation

  • Received:

  • Revised:

  • Issue Date:

  • DOI: https://doi.org/10.1007/BF02244602

Key words

Navigation