A Double-Blind Randomized Comparison of Nortriptyline and Paroxetine in the Treatment of Late-Life Depression: 6-Week Outcome

Background: Some studies have suggested that selective serotonin reuptake inhibitors may be less efficacious than tricyclic antidepressants in the treatment of severe depression in older patients. Theobjective of this study was to compare the 6-week outcome of treatment with nortriptyline and paroxetinein older patients with a major depressive episode. Method: A double-blind randomized comparison of nortriptyline and paroxetine was conducted in 80 elderly (mean ± SD age = 75.0 ± 7.4 years) psychiatric inpatients and outpatients who presented with a major depressive episode. Dropout andresponse rates were compared in patients who began or completed treatment. Rates of response of inpatientsand patients with melancholic depression were also compared. Results: Over 6 weeks, therewere no significant differences in dropout rates due to side effects (nortriptyline, 14% vs. paroxetine,19%) or for any reason (27% vs. 33%). Similarly, there were no significant differences between therates of favorable response to nortriptyline or paroxetine (intent-to-treat analysis, 57% vs. 44%; completeranalysis, 78% vs. 66%). Analyses restricted to inpatients or to patients with melancholic depressionyielded similar results. Conclusion: Nortriptyline and paroxetine appear to have similar efficacy and tolerability in the acute (6-week) treatment of older depressed patients, including hospitalizedpatients and those with melancholic features.