PAROXETINE IN THE ELDERLY - A COMPARATIVE METAANALYSIS AGAINST STANDARD ANTIDEPRESSANT PHARMACOTHERAPY

In a meta-analysis of ten studies in elderly patients, paroxetine (n = 387) was as effective an antidepressant as active controls (amitripty line n = 110, clomipramine n = 109; doxepin n = 102; mianserin n = 28) . The change over 5-6 weeks of therapy, on the Hamilton Depression Rat ing Scale, was significantly better with paroxetine compared with acti ve controls. A similar advantage was seen when the responder rate was considered. Adverse events were less frequent and less severe with par oxetine treatment, especially anticholinergic adverse events. Paroxeti ne was effective in treating anxiety symptoms associated with depressi on, yet caused significantly less sedation compared with active contro ls. There was little difference in the overall safety profiles seen be tween the paroxetine and active control groups. However, data are avai lable indicating reduced cardiotoxicity for paroxetine and a beneficia l effect on suicidal thoughts. Overall, the results indicate paroxetin e is an alternative first-line therapy to these older antidepressants and should be considered when treating elderly patients.