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Both Paroxetine, Nortriptyline Efficacious in Depressed Older Patients

Paroxetine and nortriptyline are both efficacious in the treatment of older depressed patients, however, paroxetine seems to be better tolerated, United States researchers say.

Investigators from the University of Pittsburgh and the Veteran Affairs Pittsburgh Health Care System in Pennsylvania used a double-blind, randomised study to compare 12-week clinical outcomes with the two drugs in 116 depressed older patients.

Participants had a mean age of 72 years and had presented with a major depressive episode or melancholic depression. Some participants were hospitalised; others were treated as outpatients.

Researchers compared discontinuation and response rates in patients starting and completing treatment.

"Discontinuation rate due to side effects was significantly higher with nortriptyline (33 percent) than with paroxetine (16 percent)," they report.

"There were no significant differences between the rates of response in intent-to-treat analysis or the completer analysis."

Rate of response in intent-to-treat analysis for nortriptyline was 57 percent, compared with 55 percent for paroxetine. Rate of response in completer analysis was 78 percent for nortriptyline and 84 percent for paroxetine.

The investigators concluded: "Although paroxetine appears to be better tolerated than nortriptyline, the efficacy of these two drugs does not appear to differ in the acute treatment of older depressed patients, including hospitalised patients and those with melancholic features."
American Journal of Geriatric Psychiatry, 2001; 9: 406-414 "A Twelve-Week, Double-Blind, Randomized Comparison of Nortriptyline and Paroxetine in Older Depressed Inpatients and Outpatients"

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