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Urinary MHPG and Response to Amitriptyline-Reply

George R. Heninger, MD; Dennis S. Charney, MD
Arch Gen Psychiatry. 1983;40(4):467. doi:10.1001/archpsyc.1983.01790040121019.
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In Reply.—  Dr Modai and colleagues stated that we misinterpreted their findings concerning the relationship between response to amitriptyline and urinary excretion of MHPG. The authors did find that pretreatment urinary levels of MHPG were higher in patients they classified as treatment responders than in nonresponders. However, we believe that their method of dividing patients into responders and nonresponders is without validity, thus bringing their conclusions into question.Their definition of response involved the following criteria: an initial Hamilton Depression Scale score of more than 17 points, a final Hamilton score of less than 17, and a total change of at least ten points. Patients who did not fulfill these criteria were considered nonresponders.Consequently, the authors classified as nonresponders one patient whose Hamilton score decreased from 23 to 14 and another whose score decreased from 16 to 2. In addition, those patients had the lowest and third lowest pretreatment urinary levels


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