Fluoxetine compared with amitriptyline in elderly depression: a controlled clinical trial

Area of Science:

• Geriatric Psychiatry
• Pharmacology
• Clinical Psychology

Background:

• Major depressive episodes are prevalent in elderly inpatients.
• Treatment options for geriatric depression require careful consideration of efficacy and side-effect profiles.
• Selective serotonin reuptake inhibitors (SSRIs) and tricyclic antidepressants (TCAs) are common pharmacotherapies.

Purpose of the Study:

• To compare the efficacy and tolerability of amitriptyline and fluoxetine in elderly inpatients with major depressive episodes.
• To assess the incidence of adverse events associated with each treatment.

Main Methods:

• A double-blind, randomized study involving 28 elderly inpatients diagnosed with major depressive episodes (DSM III).
• Participants received either amitriptyline (75 mg/day) or fluoxetine (20 mg/day) for five weeks.
• Hamilton Rating Scale of Depression (HAM-D) scores were used to measure depression severity at baseline and endpoint.

Main Results:

• Both amitriptyline and fluoxetine groups demonstrated significant reductions in HAM-D scores compared to baseline.
• The amitriptyline group experienced significantly more severe anticholinergic side-effects.
• Weight gain was observed exclusively in patients treated with amitriptyline.

Conclusions:

• Both amitriptyline and fluoxetine are effective in treating major depressive episodes in elderly inpatients.
• Fluoxetine appears to have a more favorable side-effect profile, with fewer anticholinergic effects and no associated weight gain compared to amitriptyline.
• These findings suggest fluoxetine may be a preferred option for geriatric depression treatment due to better tolerability.