Background: Depression is a serious and widespread emotional disorder among
the elderly. This study compared the efficacy and safety of bupropion sust
ained release (SR) with the selective serotonin reuptake inhibitor paroxeti
ne in the treatment of major depression in elderly outpatients.
Method: Elderly (greater than or equal to 60 years) outpatients with major
depressive disorder (DSM-IV criteria) were evaluated in this 6-week multice
nter, randomized, double-blind study comparing bupropion SR, 100-300 mg/day
, and paroxetine, 10-40 mg/day. Efficacy was assessed by changes in scores
on the Hamilton Rating Scales for Depression (HAM-D) and Anxiety (HAM-A) an
d the Clinical Global Impressions-Severity of Illness and -Improvement scal
es. Safety was assessed by monitoring adverse events, vital signs, and body
weight.
Results: A total of 100 patients ranging in age from 60 to 88 years were ra
ndomly assigned to treatment with bupropion SR (N = 48) or paroxetine (N =
52). Measurements of efficacy were similar between the 2 treatment groups,
with both groups showing improved scores on all depression rating scales. H
eadache, insomnia, dry mouth, agitation, dizziness, and nausea occurred in
> 10% of patients in both groups; somnolence, diarrhea, constipation, and a
norexia occurred in > 10% of patients in the paroxetine group. No statistic
ally significant differences between groups in vital signs or weight were f
ound.
Conclusion: Both bupropion SR and paroxetine were safe and effective for th
e treatment of depression in the elderly. Because of its favorable side eff
ect profile, bupropion SR may provide a safe and effective nonserotonergic
treatment alternative that is well suited as an antidepressant for the elde
rly.