Reboxetine in the treatment of depression in the elderly: Pilot study

Elderly patients are particularly susceptible to the potential side effects of current antidepressants due to age-related physiologic changes. We repo rt a pilot study to examine the tolerability of increasing doses of reboxet ine, a selective noradrenaline reuptake inhibitor (selective NRI), in elder ly depressed patients. Twelve elderly female patients (75-87 years) with ei ther major depression or dysthymia received reboxetine titrated to 8 mg/day over a 4-week period. Tolerability was assessed and included the measureme nt of vital signs. Electrocardiograms were recorded at baseline and on days 14 and 28. Newly emergent signs and symptoms were recorded throughout the study. Efficacy was assessed using four rating scales, including the Clinic al Global Impression (CGI) scale and Hamilton Depression Rating Scale (HAM- D). Eleven patients completed the study, nine received the maximal dose of reboxetine 8 mg/day, and two received maximum doses of reboxetine 6 mg/day due to cardiac rhythm changes in week 3. A total of five patients experienc ed tachycardia (including two with cardiac rhythm changes in week 3). At th e end of the study, seven patients were "much" to "very much" improved on t he CGI scale with a concomitant decrease in HAM-D total score of 22% to 41% . Reboxetine was well tolerated by the majority of patients and efficacy ou tweighed side effects in 75% of patients. Reboxetine 4 mg/day, increasing t o 6 mg/day on the basis of individual patient tolerability, may be consider ed as a safe dose range for testing the efficacy and tolerability of reboxe tine in long-term controlled clinical trials in elderly patients with depre ssion.