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A level between 50 and 150 ng/mL of nortriptyline in the blood generally corresponds with an antidepressant effect. [12] It is also used off-label for the treatment of panic disorder, ADHD, irritable bowel syndrome, tobacco-cessation, migraine prophylaxis and chronic pain or neuralgia modification, particularly temporomandibular joint disorder.
Sequenced Treatment Alternatives to Relieve Depression (STAR*D) was a collaborative study on the treatment of depression, funded by the National Institute of Mental Health. Its main focus was on the treatment of depression in patients where the first prescribed antidepressant proved inadequate.
Amisulpride (Solian) – approved in low doses as a monotherapy for persistent depression and major depressive disorder [10] Levosulpiride – approved in low doses for major depressive disorder [11] Lumateperone (Caplyta) – approved as a monotherapy for bipolar depression; Lurasidone (Latuda) – approved as a monotherapy for bipolar depression
Treatment guidelines from the National Institute of Health and Clinical Excellence [37] recommend against the use of SSRIs in this disorder. Those from the American Psychiatric Association note that SSRIs confer no advantage regarding weight gain, but that they may be used for the treatment of co-existing depression, anxiety, or OCD. [38]
Under development for the treatment of depression in the United States and Canada, it was approved by the FDA for treatment of MDD in July 2013. Milnacipran: Ixel Savella Impulsor: Fibromyalgia; Major depressive disorder [15] 1996: Milnacipran: Shown to be significantly effective in the treatment of depression and fibromyalgia. [15]
A 2016 meta-analysis of transcranial direct current stimulation (tDCS) reported some efficacy of tDCS in the treatment of acute depressive disorder with moderate effect size, and low efficacy in treatment-resistant depression, and that use of 2 mA current strength over 20 minutes per day over a short time span can be considered safe. [166]
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