The Course of Adverse Effects of Nortriptyline and Venlafaxine in Elderly Patients with Major Depression

OBJECTIVES: To evaluate tolerability and course of adverse effects of antidepressants in elderly patients and to study the association between number and severity of adverse effects and age, physical comorbidity, antidepressant dose. and depression severity. DESIGN: Double‐blind, randomized controlled trial followed by an open treatment phase of 3 years. SETTING: Psychiatric hospital in the Netherlands. PARTICIPANTS: Eighty‐one elderly depressed inpatients. INTERVENTION: Patients were treated with venlafaxine or nortriptyline. MEASUREMENTS: Frequency and severity of 43 individual adverse effects were assessed using the Symptom, Sign, Side‐Effect Checklist. Severity of depression was assessed using the Montgomery Åsberg Depression Rating Scale. RESULTS: Both antidepressants were tolerated well, with no differences in clinical effectiveness, and most adverse effects decreased with time. The number and severity of adverse effects was not related to age or physical comorbidities. There was a significant relationship between the severity of depression and the severity of adverse effects, although the relationship between the dose of the antidepressant and the severity of the adverse effects was of only borderline statistical significance. CONCLUSION: Elderly patients tolerated venlafaxine and nortriptyline well, and most adverse effects decreased with time as the depression improved. Age and physical comorbidities were not related to number and severity of adverse effects.