Table of Contents
ISRN Pharmaceutics
Volume 2011, Article ID 805983, 6 pages
Research Article

Pharmacogenetics and Gender Association with Psychotic Episodes on Nortriptyline Lower Doses: Patient Cases

1Diversity Health Institute, Western Sydney Local Health District, North Parramatta, NSW 2151, Australia
2DHI Lab, ICPMR Building, Westmead Hospital, Level 2 Westmead, NSW 2145, Australia

Received 6 April 2011; Accepted 20 May 2011

Academic Editors: E. Hassan, G. Lentini, and C. Saturnino

Copyright © 2011 Irina Piatkov and Trudi Jones. This is an open access article distributed under the Creative Commons Attribution License, which permits unrestricted use, distribution, and reproduction in any medium, provided the original work is properly cited.


The variation in individual responses to psychotropic drug treatment remains a critical problem in the management of psychotic disorders. Although most patients will experience remission, some patients may develop drug-induced adverse effects that may range from troublesome to life threatening. Antidepressants are freely prescribed by general practitioners, and there should be constant awareness in the medical community about possible serious side effects. We describe two cases of adverse drug reactions on low dosage treatment that led to extreme psychotic episodes as examples of the potential for dangerous side effects. The patients developed adverse reactions on the normal recommended dosage of nortriptyline, a tricyclics antidepressant (TCA). Both were females, with no history of antidepressant treatment, unsocial behaviour, nor any family history of psychosis, but both experienced severe psychiatric symptoms. Pharmacogenetic tests can easily be performed and interpreted according to the likelihood of adverse reactions and should be included in toxicity interpretation.