Nortriptyline Abuse: A Case Report and Review of the Literature.

The tricyclic antidepressants have long been a tool in the physician's armament for numerous indications, the most prominent of which being depression. Although their efficacy and side effects have been well documented, less known is their abuse. Prior literature has discussed this more for the tertiary amines such as amitriptyline, but currently, there are no documented cases of abuse with the secondary amine nortriptyline.

Treatment of Depression With Duloxetine in Mitochondrial Encephalopathy, Lactic Acidosis, and Stroke-Like Episodes.

The mitochondrial cytopathies are a heterogeneous group of diseases characterized by heteroplasmic maternal transmission and selective dysfunction of tissues and organs highly dependent on aerobic respiration (eg, skeletal muscle, cardiac muscle, and brain). Mitochondrial encephalomyopathy with lactic acidosis and stroke-like episodes (MELAS) is a specific subtype of mitochondrial cytopathy that is commonly associated with mood disturbances in individuals who survive until adulthood. Because of the altered cellular metabolism inherent in MELAS, it is often difficult to determine drug dosing, drug choice, and treatment response in patients with this rare disease.