Paroxetine and nortriptyline showed similar efficacy for depression (65.9% vs 72.5% response), but paroxetine had significantly fewer adverse event-related discontinuations (5% vs 25%).
RCT (n=81)
Double-blind
randomly assigned
Does paroxetine compared to nortriptyline improve depression symptoms and tolerability in patients with ischemic heart disease and major depression?
In patients with ischemic heart disease and major depression, paroxetine is as efficacious as nortriptyline but is better tolerated with fewer cardiovascular side effects.
Absolute Event Rate: 65.9% vs 72.5%
OBJECTIVE: This study compared the efficacy, tolerability, and safety of paroxetine and nortriptyline in depressed patients with ischemic heart disease. METHOD: After a 2-week, single-blind placebo lead-in phase, 81 outpatients with DSM-III-R-defined nonpsychotic unipolar major depression and ischemic heart disease were randomly assigned to double-blind treatment with paroxetine or nortriptyline for 6 weeks. Paroxetine was administered at a fixed-flexible dose of 20-30 mg/day. Nortriptyline dose was adjusted with the use of blood-level monitoring to reach a plasma concentration of 50-150 ng/ml. RESULTS: Twenty-seven of the 41 patients who started treatment with paroxetine and 29 of the 40 patients who started treatment with nortriptyline had an improvement of at least 50% in their Hamilton Depression Rating Scale scores. Significantly more patients taking nortriptyline discontinued treatment prematurely (35% versus 10%), and more patients taking nortriptyline had adverse events resulting in termination (25% versus 5%). CONCLUSIONS: Both treatments were efficacious. Sixty-three percent of all patients improved at least 50%, and of these, 90% met the criteria for remission. Paroxetine was better tolerated than nortriptyline and less likely to produce cardiovascular side effects.
Nelson et al. (Thu,) conducted a rct in Major depression and ischemic heart disease (n=81). Paroxetine vs. Nortriptyline was evaluated on Improvement of at least 50% in Hamilton Depression Rating Scale scores. Paroxetine and nortriptyline showed similar efficacy for depression (65.9% vs 72.5% response), but paroxetine had significantly fewer adverse event-related discontinuations (5% vs 25%).