[Comparative efficacy of citalopram and nortriptyline in geriatric patients with major depressive disorder]

ABSTRACT

Major depressive disorder is a common and disabling disorder that causes high rates of morbidity and mortality. Nortriptyline is a tricyclic antidepressant that has been used for geriatric depression since a long time ago. Prescription of SSRIs in geriatric depression has been increased recently, because of more favorable profile of their side effects. This study designed to compare the efficacy of nortriptyline and citalopram in geriatric depression, Because of the importance of choosing the most appropriate medication in geriatric population. The present study was a single blind clinical trial, performed from February 2005 for a one year period. Patients age above 60 years referred to Ibne-sina hospital with the confirmed diagnosis of major depressive disorder, based on DSM-IV-TR criteria, were included in the study. These patients were randomly divided into two groups one group [n= 37] taking citalopram 10-20 mg/day and the other group taking nortriptyline 25-150 mg/day [with the mean dose of 100 mg/day]. The efficacies of medications were assessed after 8 weeks based on the change in HDRS. Finally, 72 patients completed the study and 13 patients [5 from citalopram group, 8 from nortriptyline group], for different reasons discontinued the medication. Data analyzed using descriptive statistical tests and chi square. Demographic data and HDRS scores did not show statistical considerable variance in the two groups. Also, Changes in HRDS scores before the treatment and after 8 weeks were not significantly different between them. Insomnia was seen in 5 patients taking citalopram [13.4%]. Three patients [8.1%] in the citalopram group and one patient [2.8%] in the nortriptyline group complained from nausea in the early treatment phase. Headache was seen in 8.1% and 2.8% in the groups taking citalopram and nortriptyline, respectively. In the patients taking nortriptyline, the most prevalent complaints were dry mouth [28.5%] and drowsiness [22.8%]. Results showed that both drugs are efficient in the reduction of geriatric depressive symptoms and HRDS scores decrease was more than 50% in both groups. No significant difference was seen between the efficacy of two drugs and this result is consistent with the previous studies. These findings need to be confirmed with further researches