A Double-blind Study Comparing Paroxetine and Maprotiline in Depressed Outpatients

Abstract

A double-blind multicenter randomized parallel group study comparing paroxetine and maprotiline was carried out in a total of 544 outpatients. Included were patients with varying degrees of severity of depressive symptoms who fulfilled modified RDC criteria for either Minor or Major Depression and showed a HAMD-17 score of > or = 13. No concomitant benzodiazepine treatment was allowed. Duration of treatment was 6 weeks, after an initial wash-out period. Doses were fixed during the first 3 weeks of treatment, patients receiving either 20 mg paroxetine or 100 mg maprotiline daily. An option for dose escalation was provided for insufficient responders after 3 weeks. The weekly assessments comprised rating of the HAMD-17, MADRS, BRMS, RDS, HAMA, CAS, and CGI scales and registration of adverse events by non-leading questions. An intention-to-treat and a completer analysis were performed. Response was defined as a HAMD-17 reduction of > or = 50% or a HAMD-17 score of < or = 9 at the end of the study or at dropout. The treatment groups were comparable according to demographic data. Overall evaluation indicated equieffective and good antidepressant and anxiety-reducing properties for paroxetine and maprotiline. No persistent significant differences between treatment groups were observed on any assessment instrument. There was no difference in the frequency of observed side-effects, but side-effect profiles were markedly different, as maprotiline patients had more anticholinergic and paroxetine patients more SSRI-typical side-effects.

A comparative, randomised, double-blind study of trazodone prolonged-release and paroxetine in the treatment of patients with major depressive disorder

“…The high percentages of responders observed in this study, although reported previously in other studies 10,[22][23][24] , are probably in part due to an additive placebo effect, which includes the beneficial effects of increased patient-clinician interaction. The lack of a placebo-controlled arm does not allow this effect to be quantified exactly.…”

Antidepressants and brain monoaminergic systems: a dimensional approach to understanding their behavioural effects in depression and anxiety disorders

“…Although not listed in DSM-IV as a diagnostic criterion for MDD, it has been estimated that as many as 85 % of adults with depression have significant symptoms of anxiety (Gorman, 1996(Gorman, /1997. In this context, it is clear that all existing antidepressants successfully ameliorate anxiety as a component of depression, including those that selectively block NE reuptake (Ferguson et al, 2002;Kleber, 1979;Nelson, 1999;Nystrom and Hallstrom, 1985;Stahl et al, 2002;Szegedi et al, 1997), as well as bupropion (Trivedi et al, 2001) and mirtazapine (Fawcett and Barkin, 1998), which has a prominent noradrenergic component to its complex pharmacology (Frazer, 1997). Later in this review, with respect to the specific behavioural dimensions that may be affected by drugs regulating noradrenergic and serotonergic function, we will discuss how it may be that SSRIs can be effective in both MDD and the various anxiety disorders, whereas selective NRIs seem to improve non-specific symptoms of anxiety, but are less effective against other symptoms, e.g.…”

Paroxetine: A Review

“…Subsequent clinical trials have compared paroxetine with tricyclic and related antidepressants, demonstrating approximate therapeutic equivalence between treatment groups (3,23,71,86,95,96,103,104). A large study, involving 717 outpatients with major depression, demonstrated reduction of baseline HDRS scores by 37.9% with paroxetine, 35.1% with imipramine, and 21.8% with placebo.…”