A randomised, double-blind comparison of the efficacy and safety of citalopram compared to mianserin in elderly, depressed patients with or without mild to moderate dementia

Depression is the most common psychiatric disorder among the elderly and in old age may interact with emotional and cognitive functioning. Depression in old age has been shown to be associated with degenerative changes in the brain. It is, therefore, important that in this patient population antidep ressants with a favourable tolerability profile, such as the selective sero tonin reuptake inhibitors (SSRIs), are examined for both antidepressant eff icacy and effect on cognitive function and emotional impairment. This rando mised, double-blind study compared the efficacy and tolerability of citalop ram and mianserin in 336 elderly, depressed patients with or without dement ia. Patients received either citalopram 20-40 mg/day or mianserin 30-60 mg/ day for 12 weeks. The treatments were equivalent with respect to change in Montgomery-Asberg Depression Rating Scale (MADRS) total score; patients in both treatment groups responded well. Patients with dementia showed a small er decrease in total MADRS score than patients without dementia. Both treat ments were well tolerated with a relatively low incidence of adverse events . Fatigue and somnolence were more frequent with mianserin, while insomnia was more frequent with citalopram. Overall, this study showed that the two treatments were equivalent in efficacy, and that citalopram is an effective , well-tolerated and non-sedative treatment for elderly depressed patients with or without dementia. Copyright (C) 2000 John Wiley & Sons, Ltd.