Single-blind Comparison of Venlafaxine and Nortriptyline in Elderly Major Depression

Abstract

The objective of this single-blind study was to compare the efficacy and safety of venlafaxine extended-release and nortriptyline in elderly patients with moderate to severe major depression. In- and out-patients (N=68) with unipolar major depression were randomized to receive 6-month treatment with either nortriptyline or venlafaxine. Outcomes of the two groups were compared using measures including the Hamilton Depression Rating Scale (HDRS) and the Newcastle Scale. Side effects were assessed with the UKU side-effect rating scale. Of the 34 venlafaxine-treated patients, 22 were remitters, 7 were nonremitters, and 5 dropped out. The intent-to-treat remission rate was 71% (22 of 31). Of the 34 who received nortriptyline, 21 were remitters, 7 were nonremitters, and 6 dropped out. The intent-to-treat remission rate was 70% (21 of 30). These results suggest that the remission rate with a therapeutic plasma level of nortriptyline is similar to the remission rate with a standard dose of venlafaxine in this group of elderly major depressed patients. No significant differences were observed between dropout rates in the two groups, but autonomic side-effects were significantly more frequent for nortriptyline than for venlafaxine. These results confirm the efficacy and safety of venlafaxine extended-release for treating elderly major depression.

Efficacy and tolerability of venlafaxine in geriatric outpatients with major depression: a double‐blind, randomised 6‐month comparative trial with citalopram

“…The effects of the treatments were comparable and there were no statistically significant differences between the treatment groups for any of the study endpoints. Overall, the results are consistent with and corroborate those from other studies with venlafaxine in geriatric patient populations (Khan et al, 1995;Dierick, 1996;Amore et al, 1997;Mahapatra and Hackett, 1997;Zimmer et al, 1997;Smeraldi et al, 1998;Gastó et al, 2003). The observed remission rate was somewhat lower than reported in a meta-analysis of eight comparative studies conducted in 2045 patients between 18 and 83 years.…”

“…The use of venlafaxine is well established in adults but there is less experience from its use in elderly subjects. Three open-labelled studies have been published on the use of venlafaxine in geriatric subjects with major depression (Khan et al, 1995;Dierick, 1996;Amore et al, 1997) and three randomised trials comparing venlafaxine against the tricyclic antidepressants dothiepin (Mahapatra and Hackett, 1997), clomipramine (Smeraldi et al, 1998) and nortriptyline (Gastó et al, 2003), respectively. Collectively, the results from these studies demonstrate the effectiveness and tolerability of venlafaxine in the elderly.…”

Venlafaxine extended-release in patients older than 80 years with depressive syndrome

“…It is interesting to note that in this study group there were no significant changes in blood pressure, as have been seen in several other venlafaxine trials (Mahapatra and Hackett, 1997;Gastó et al, 2003;Cervera-Enguix et al, 2004). It is important to consider that the mean dosage of venlafaxine at the final visit was 94.2 mg/day, while a large meta-analysis reported an increase in blood pressure at doses higher than 300 mg/day (Thase, 1998).…”

A Systematic Review of Antidepressant Placebo-Controlled Trials for Geriatric Depression: Limitations of Current Data and Directions for the Future

“…Available data supporting its role in depression include open-label trials and clinical trials comparing venlafaxine with other antidepressants, but not placebo. Venlafaxine has been compared against clomipramine and trazodone (Smeraldi et al, 1998), nortriptyline (Gasto et al, 2003), and dothiepin, a TCA used in Europe (Mahapatra and Hackett, 1997). In these studies, venlafaxine exhibited superiority to trazodone (Smeraldi et al, 1998), but otherwise the response rate was comparable between venlafaxine and its comparators.…”