Bupropion sustained release versus paroxetine for the treatment of depression in the elderly

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.