Sertraline versus paroxetine in major depression: Clinical outcome after six months of continuous therapy

Relatively little research is available comparing the efficacy and tolerabi lity of selective serotonin reuptake inhibitors (SSRIs) during continuation therapy. This investigation reports the differential effect of 6 months of treatment with sertraline versus paroxetine for symptoms of depression, qu ality of life, and personality outcomes. Outpatients with unipolar major de pression (DSM-III-R) were randomly assigned to receive 24 weeks of double-b lind treatment with flexible doses of paroxetine (20-40 mg) or sertraline ( 50-150 mg). Assessments included the Montgomery-Asberg Depression Rating Sc ale (MADRS), the Clinical Global Impression Scale, the Battelle Quality of Life Questionnaire, and the Structured Clinical Interview for DSM-III-R Per sonality Disorders screen questionnaire. One hundred seventy-six patients ( mean age, 43 years; 64% female; baseline MADRS, 30.3) were treated with ser traline and 177 patients (mean age, 42 years; 71% female; MADRS, 30.7) with paroxetine. Antidepressant efficacy during continuation therapy was sustai ned, with only 2% of patients receiving sertraline and 9% of patients recei ving paroxetine suffering a relapse. Continuation therapy resulted in a sub stantial conversion of responders during short-term treatment to full remis sion: remitter rates increased from 52% to 80% for sertraline and from 57% to 74% for paroxetine. The improvements in quality of life were related to a reduced depression score. SSRI treatment had significant beneficial effec ts on both categorical and dimensional measures of personality. A logistic regression analysis identified early response (25% reduction in MADRS score s at week 2) as the most important predictor of treatment response, whereas high severity, chronicity, and poor baseline quality of life had no effect . Both treatments were well-tolerated, with sertraline having a somewhat lo wer side effect profile. Sertraline and paroxetine demonstrated comparable efficacy during short-term and continuation therapy. Treatment was associat ed with significant improvement in quality of life and with reductions in a xis II personality psychopathology.