Treatment of major depression with nortriptyline and paroxetine in patients with ischemic heart disease

Objective: This study compared the efficacy, tolerability, and safety of pa roxetine and nortriptyline in depressed patients with ischemic heart diseas e. Method: After a 2-week, single-blind placebo lead-in phase, 81 outpatien ts with DSM-lll-R-defined nonpsychotic unipolar major depression and ischem ic heart disease were randomly assigned to double-blind treatment with paro xetine or nortriptyline for 6 weeks. Paroxetine was administered at a fixed -flexible dose of 20-30 mg/day. Nortriptyline dose was adjusted with the us e of blood-level monitoring to reach a plasma concentration of 50-150 ng/ml . Results: Twenty-seven of the 41 patients who started treatment with parox etine and 29 of the 40 patients who started treatment with nortriptyline ha d an improvement of at least 50% in their Hamilton Depression Rating Scale scores. Significantly more patients taking nortriptyline discontinued treat ment prematurely (35% versus 10%), and more patients taking nortriptyline h ad adverse events resulting in termination (25% versus 5%). Conclusions: Bo th treatments were efficacious. Sixty-three percent of all patients improve d at least 50%, and of these, 90% met the criteria for remission. Paroxetin e was better tolerated than nortriptyline and less likely to produce cardio vascular side effects.