Paroxetine in the Elderly: A Comparative Meta-Analysis against Standard Antidepressant Pharmacotherapy

Abstract

In a meta-analysis often 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.

Paroxetine: A Review

“…Untreated or suboptimally treated depressed patients have an increased risk of suicide attempts, longer periods of disability and increased rates of hospitalization (57,73). Clinical trials have compared paroxetine to placebo, imipramine, clomipramine, amitriptyline, dothiepin, doxepin (31), lofepramine, maprotiline, and mianserin (30,45,105). Paroxetine has also been campared in review articles with other SSRIs, including fluoxetine, fluvoxamine, and sertraline (41,43), nefazodone (8), as well as electroconvulsive therapy (ECT) (37).…”

Cognitive-Behavioural Therapy Combined with Antidepressants for Major Depressive Disorder

“…Numerous systemic reviews are conducted to summarize the efficacy and tolerability of SSRIs in treating elderly patients with depression. A meta-analysis of Dunbar (1995) including ten studies carried out in elderly depressed patients demonstrated that paroxetine is as effective as other agents (amitriptyline, clomipramine, doxepin, mianserin). However, the adverse effects of paroxetine might be less frequent and less.…”

Late-Life Depression: Rationalizing Pharmacological Treatment Options

“…Comparative studies of SSRIs and TCAs in the elderly have shown an improved tolerability profile for SSRIs [65,75,79,90]. Infrequent differential effects, such as hyponatraemia and extrapyramidal symptoms, have been reported with SSRIs in elderly patients [91]; however, the significantly greater incidence of adverse events with TCAs compared with SSRIs make the latter the drugs of choice for depression in the elderly [76,79,92].…”