Paroxetine versus amitriptyline for treatment of depression associated with rheumatoid arthritis: A randomized, double blind, parallel group study

Objective. To compare the efficacy and tolerability of paroxetine (a select ive serotonin reuptake inhibitor) with that of amitriptyline (a tricyclic a ntidepressant) in the treatment of depression in 191 patients with rheumato id arthritis (RA). Methods. A randomized, double blind, double dummy, parallel group study. A placebo washout period of 3-7 days was Followed by an 8 week active treatme nt phase during which patients received either paroxetine (20-40 mg daily) or amitriptyline (75-150 mg daily). The primary efficacy variable was the c hange from baseline in Montgomery Asberg Depression Rating Scale score at e ndpoint. Results. Paroxetine was as effective as amitriptyline for the treatment of depression, with similar improvements in RA associated pain and disability also seen in both groups. However, paroxetine was better tolerated than ami triptyline, with an overall frequency of adverse experiences of 56.4% and 6 7.7% in the 2 groups, respectively. The frequency of anticholinergic advers e experiences was much lower in the paroxetine treatment group (18.1% vs 43 .8% taking amitriptyline) and paroxetine treated patients als!, experienced fewer severe (16.0% vs 21.9%), serious nonfatal (0% vs 4.2%), and drug rel ated adverse experiences (12.8% vs 29.2%). Conclusion. Tolerability is an important consideration in this patient popu lation, which is largely composed of elderly patients who are taking additi onal medications for RA. Paroxetine shows a number of advantages in the man agement of depression comorbid with RA.