Antidepressant Efficacy and Safety of Low-Dose Sertraline and Standard-Dose Imipramine for the Treatment of Depression in Older Adults: Results From a Double-Blind, Randomized, Controlled Clinical Trial

Abstract

This study compared the efficacy and tolerability of 150 mg/day imipramine and 50 mg/day sertraline for the treatment of a major depressive episode (DSM-IV) in older adults (N = 55) in an 8-week, randomized, double-blind, controlled clinical trial. Intention-to-treat analysis (last observation carried forwards) showed a reduction of 50% or more on the baseline scores of the Montgomery-Åsberg Rating Scale (MADRS) in 60.7% and 55.6% of patients receiving imipramine and sertraline, respectively (p = .698). Full remission of symptoms (MADRS < 9) was observed in 50.0% and 51.8% of patients, respectively (p = .891). Side effects were more frequent among patients treated with imipramine (86.7%) than among patients treated with sertraline (42.1%) (p = .008). Dropout rates were high in both groups (46.4% and 29.6% respectively, p = .200). These results indicate that imipramine and sertraline are equally effective for the treatment of major depression in later life, although adverse reactions are more frequent among subjects treated with imipramine than with sertraline.

Hippocampal volume and antidepressant response in geriatric depression

“…This study aimed to examine remission based on a categorical MADRS score less than ten. Other studies have used MADRS scores ranging from less than 9 to less than 12 to define remission (Forlenza et al, 2001;Schweitzer et al, 2001). Thus, the cut-off of less than 10 in the present study seems reasonable.…”

Efficacy of treatment in older depressed patients: A systematic review and meta-analysis of double-blind randomized controlled trials with antidepressants

“…We were able to find the vast majority of studies identified as unpublished in previous reviews (Bondareff et al, 2000;Branconnier et al, 1982;Forlenza et al, 2001;Guelfi et al, 1999;Hoyberg et al, 1996;Katona et al, 1998;Newhouse et al, 2000;Roose et al, 2004;Schatzberg and Roose, 2006;Schatzberg et al, 2002;Smeraldi et al, 1998;Trick et al, 2004;Wehmeier et al, 2005).…”

“…In the 16 RCTs that used our primary outcome criterion of remission, no significant difference could be demonstrated between treatment with a TCA compared neither with SSRIs (five RCTs; Forlenza et al, 2001;Guillibert et al, 1989;Kyle et al, 1998;Limosin et al, 2006;Wehmeier et al, 2005) nor with other antidepressants (7 RCTs; Georgotas et al, 1986; Gerner et al, 1980;Kok et al, 2007;Nair et al, 1995;Tignol et al, 1998;Trick et al, 2004;Waite et al, 1986), nor between SSRIs compared with other antidepressants (four RCTs; Falk et al, 1989;Karlsson et al, 2000;Schatzberg and Roose, 2006;Schatzberg et al, 2002) (Fig. 4).…”

“…In the 27 RCTs that used our secondary outcome criterion response, no significant difference could be demonstrated between TCAs and SSRIs (11 studies with OR 0.85; 95% CI = 0.69-1.04) (Bondareff et al, 2000;Cohn et al, 1990;Feighner and Cohn, 1985;Forlenza et al, 2001;Geretsegger et al, 1995;Hutchinson et al, 1991;Kyle et al, 1998;Limosin et al, 2006;Rahman et al, 1991;Wakelin, 1986;Wehmeier et al, 2005), nor between TCAs and other antidepressants (7 studies with OR 1.29; 95% CI = 0.95-1.75) (Hoyberg et al, 1996;Kok et al, 2007;Mahapatra and Hackett, 1997;Nair et al, 1995;Schifano et al, 1990;Tignol et al, 1998;Trick et al, 2004), nor between SSRIs and other antidepressants (9 studies with OR 1.81; 95% CI = 0.85-3.89) (Allard et al, 2004;Bocksberger et al, 1993;Dalery and Aubin, 2001;Dorman, 1992;Guelfi et al, 1999;Karlsson et al, 2000;Oslin et al, 2003;Schatzberg et al, 2002;Weihs et al, 2000). Excluding both studies (Karlsson et al, 2000;Oslin et al, 2003) that included a small minority of patients with dementia and depression did not have a significant change on the results.…”

Long-term sertraline treatment increases expression and decreases phosphorylation of glycogen synthase kinase-3B in platelets of patients with late-life major depression

“…The aim of the present study is to evaluate the effect of short-and long-term antidepressant treatment with sertraline on the expression of total and phosphorylated GSK3B in platelets of patients with latelife major depression. Sertraline was chosen in this study because it is widely used as a safe and effective drug for the treatment of major depression in the elderly (Forlenza et al, 2001). Moreover, it has been shown to improve cognitive performance in these patients (Devanand et al, 2003).…”