Reboxetine versus imipramine in the treatment of elderly patients with depressive disorders: a double-blind randomised trial

Background: Depression in older people is often unrecognised and untreated or under-treated. Antidepressant treatment may itself exacerbate a pre-exis ting illness, interact with concomitant medications or produce undesirable cognitive and sedative side effects. Newer antidepressants may offer advant ages in terms of a lesser burden of adverse effects. Methods: The comparati ve tolerability of the unique selective noradrenaline reuptake inhibitor (s elective NRI) reboxetine (4-6 mg/day; n = 176) and that of imipramine (50-1 00 mg/day; n = 171) was assessed in an elderly (> 65 years) cohort of depre ssed or dysthymic patients in an 8-week, double-blind, multicentre trial. C omparative efficacy was also assessed. Results: Overall, 68% of patients in the reboxetine group experienced adverse events compared with 71% in the i mipramine group. Reboxetine-treated patients were less likely to develop hy potension and related symptoms (7% vs, imipramine 16%) or cardiovascular di sorders (12.5% vs. imipramine 21.1%), while those treated with imipramine w ere less Likely to experience insomnia (6.3% vs. 2.9%). Adverse events were more often assessed as related to treatment (43%) and moderate to severe i n intensity (73%) with imipramine than with reboxetine (33% and 65%, respec tively). Furthermore, there were fewer serious adverse events in the reboxe tine-treated group (P = 0.019). The reduction in the Hamilton Rating Scale for Depression (HAM-D) was comparable between the treatment groups in the t otal population. At the last assessment, the majority of patients in both t reatment groups were assessed as normal to borderline or mildly ill using t he Clinical Global Impression (CGI) scale. in a subanalysis of the dysthymi c patients a modest but significant difference in favour of imipramine was observed for both HAM-D and CGI assessments. This may have been a reflectio n of a trend towards more severe depressive symptoms at baseline in the reb oxetine group. Conclusions: Reboxetine is as effective as imipramine in the treatment of depression in elderly patients but is at least as well tolera ted with a lower risk of hypotension and related symptoms, fewer serious ad verse events, adverse event-related withdrawals and treatment-related adver se events. (C) 1999 Elsevier Science B.V. All rights reserved.