A twelve-week, double-blind, randomized comparison of nortriptyline and paroxetine in older depressed inpatients and outpatients

Selective serotonin reuptake inhibitors may be less efficacious than tricyc lic antidepressants in the treatment of severe depression in older patients . The authors compared the 12-week clinical outcome of older depressed pati ents treated with nortriptyline or paroxetine in a double-blind randomized comparison in 116 psychiatric inpatients and outpatients (mean age: 72 +/-8 years) who presented with a major depressive episode or melancholic depres sion. Discontinuation and response rates were compared inpatients who began or who completed treatment. The discontinuation rate due to side effects w as significantly higher with nortriptyline than with paroxetine (33% Vs. 16 %). There were no significant differences between the rates of response in the Intent-to-Treat analysis (nortriptyline: 57% vs. paroxetine: 55%), or t he Completer analysis (nortriptyline: 78% vs. paroxetine: 84%). Altbough pa roxetine appears to be better tolerated than nortriptyline, the efficacy of these two drugs does not appear to differ in the acute treatment of older depressed patients, including hospitalized patients and those with melancho lic features.