Comparison of Sertraline and Nortriptyline in the Treatment of Major Depressive Disorder in Late Life

Abstract

Primary efficacy measures showed sertraline and nortriptyline to be similarly effective. With secondary outcome measures there was consistent evidence of an advantage for the sertraline-treated group. The clinical impact of these measures on the long-term well-being of elderly depressed patients should be examined in a study of maintenance treatment.

Cognitive Effects of Pharmacotherapy for Major Depressive Disorder

“…In some studies, other psychotropic agents were tested: apomorphine, 13 lithium, 48 estrogen, 49 the serotonin-reuptake enhancer tianeptine, 24 the antipsychotics aripiprazole 54 and amisulpride, 50 the mineralocorticoid receptor modulators fludrocortisone and spironolactone, 53 the cognition-enhancing drugs galantamine 46 and donepezil, 51 the dissociative anesthetic/ N-methyl-d-aspartate antagonist ketamine, 40 and the d-amphetamine prodrug lisdexamfetamine dimesylate. 44 Assessment of cognitive function was described as a primary/coprimary assessment in 32 reports (24 monotherapy*; 8 augmentation 44,46,47,49,[51][52][53][54] ) and as a secondary assessment in 9 reports (6 monotherapy 14,20,23,36,39,40 ; 3 augmentation 45,50,55 The cognitive domains assessed included processing speed, psychomotor function, attention, verbal learning and memory, verbal fluency, visuospatial awareness, and executive function. In some of the reports, the assessment instruments used are identified as measures of one or more specific domains of cognitive function.…”

A Randomized, Controlled Trial of the Effectiveness of Cognitive–Behavioral Therapy and Sertraline versus a Waitlist Control Group for Anxiety Disorders in Older Adults

“…8 Our findings indicate that the reluctant attitude of both researchers and general practitioners toward the use of SSRIs in late life may be unjustified. Given the fact that four participants (14%) did report adverse effects to sertraline as a reason for dropping out of the trial, which is comparable to dropout rates resulting from side effects in studies of sertraline for depression in late life (11%-19% 15,29,30 ), patients should be closely monitored and better informed on what to expect from an SSRI by their physician to increase treatment adherence.…”

Diretrizes da World Federation of Societies of Biological Psychiatry (WFSBP) para tratamento biológico de transtornos depressivos unipolares, 1ª parte: tratamento agudo e de continuação do transtorno depressivo maior

“…A eficácia e a segurança da nortriptilina para o tratamento de depressão maior em idosos foi bem estabelecida em estudos controlados com placebo e em ensaios clínicos comparando-a com outros antidepressivos (Nível A) (Flint, 1998;Roose e Suthers, 1998;Reynolds et al, 2001). A eficácia e a segurança dos ISRSs nos pacientes idosos depressivos foi avaliada em alguns ensaios clínicos com a sertralina, a paroxetina e a fluoxetina (Nível A) (Dunner et al, 1992;Tollefson et al, 1995;Roose e Suthers, 1998;Mulsant et al, 1999;Bondareff et al, 2000). Num ensaio clínico randomizado e controlado comparando a sertralina com a fluoxetina, ambos os medicamentos tiveram eficácia semelhante para o tratamento de pacientes idosos deprimidos acompanhados ambulatorialmente (Newhouse et al, 2000).…”