Paroxetine in the elderly: a comparative meta-analysis against standard antidepressant pharmacotherapy

In a meta-analysis of ten studies in elderly patients, paroxetine (n = 387) was as effective an antidepressant as active controls (amitriptyline n = 110; clomipramine n = 109; doxepin n = 102; mianserin n = 28). The change over 5-6 weeks of therapy, on the Hamilton Depression Rating Scale, was significantly better with paroxetine compared with active controls. A similar advantage was seen when the responder rate was considered. Adverse events were less frequent and less severe with paroxetine treatment, especially anticholinergic adverse events. Paroxetine was effective in treating anxiety symptoms associated with depression, yet caused significantly less sedation compared with active controls. There was little difference in the overall safety profiles seen between the paroxetine and active control groups. However, data are available indicating reduced cardiotoxicity for paroxetine and a beneficial effect on suicidal thoughts. Overall, the results indicate paroxetine is an alternative first-line therapy to these older antidepressants and should be considered when treating elderly patients.