Comparison of sertraline and nortriptyline in the treatment of major depressive disorder in late life

Objective: This study was designed to evaluate the comparative efficacy and safety of sertraline and nortriptyline for the treatment of major depressi ve disorder in older adults. Method: A double-blind, parallel group design was used to compare 210 outpa tients, 60 years of age and older, who met DSM-III-R criteria for major dep ressive episode and had a minimum Hamilton Depression Rating Scale score of 18. The patients were randomly assigned to 12 weeks of treatment with eith er sertraline (50-150 mg/day) or nortriptyline (25-100 mg/day). Results: The safety profiles of the two treatments were similar except that nortriptyline treatment was associated with a significant increase in puls e rate, whereas sertraline was associated with a nonsignificant decrease. E fficacy of both drugs was similar for both treatments at all time points, w ith 71.6% (N=53 of 74) of the sertraline-treated patients and 61.4% (N=43 o f 70) of the nortriptyline-treated patients achieving responder status by w eek 12. Time to response was also similar, with more than 75% of the improv ement in scores on the Hamilton depression scale having occurred by week 6. Secondary efficacy measures (posttreatment measures of cognitive function, memory and quality of life) revealed a significant advantage for sertralin e treatment. Conclusions: Primary efficacy measures showed sertraline and nortriptyline to be similarly effective. With secondary outcome measures there was consis tent evidence of an advantage for the sertraline-treated group. The clinica l impact of these measures on the longterm well-being of elderly depressed patients should be examined in a study of maintenance treatment.