Bupropion sustained release versus paroxetine for the treatment of depression in the elderly.
ABSTRACT Depression is a serious and widespread emotional disorder among the elderly. This study compared the efficacy and safety of bupropion sustained release (SR) with the selective serotonin reuptake inhibitor paroxetine in the treatment of major depression in elderly outpatients.
Elderly (> or = 60 years) outpatients with major depressive disorder (DSM-IV criteria) were evaluated in this 6-week multicenter, randomized, double-blind study comparing bupropion SR, 100-300 mg/day, and paroxetine, 10-40 mg/day. Efficacy was assessed by changes in scores on the Hamilton Rating Scales for Depression (HAM-D) and Anxiety (HAM-A) and the Clinical Global Impressions-Severity of Illness and -Improvement scales. Safety was assessed by monitoring adverse events, vital signs, and body weight.
A total of 100 patients ranging in age from 60 to 88 years were randomly assigned to treatment with bupropion SR (N = 48) or paroxetine (N = 52). Measurements of efficacy were similar between the 2 treatment groups, with both groups showing improved scores on all depression rating scales. Headache, insomnia, dry mouth, agitation, dizziness, and nausea occurred in > 10% of patients in both groups; somnolence, diarrhea, constipation, and anorexia occurred in > 10% of patients in the paroxetine group. No statistically significant differences between groups in vital signs or weight were found.
Both bupropion SR and paroxetine were safe and effective for the treatment of depression in the elderly. Because of its favorable side effect profile, bupropion SR may provide a safe and effective nonserotonergic treatment alternative that is well suited as an antidepressant for the elderly.
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ABSTRACT: To identify drugs associated with the complaint of dry mouth. MEDLINE was searched for papers 1980-2002 using keywords, oral, mouth, salivary, drugs, dry mouth and xerostomia, and relevant secondary references were hand-searched. Evidence was forthcoming for a number of xerogenic drugs, especially antimuscarinic agents, some sympathomimetic agents, and agents affecting serotonin and noradrenaline uptake, as well as a miscellany of other drugs such as appetite suppressants, protease inhibitors and cytokines. Dry mouth has a variety of possible causes but drugs--especially those with anticholinergic activity against the M3 muscarinic receptor--are the most common cause of reduced salivation.Oral Diseases 08/2003; 9(4):165-76. DOI:10.1034/j.1601-0825.2003.03967.x · 2.40 Impact Factor
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ABSTRACT: Many of the patients with depression fail to achieve an adequate response to a given antidepressant. Depression is often overlooked in elderly persons, which may produce a greater risk of suicide in this age group. The antidepressive characteristic of bupropion has been already validated in several studies. However, to the best of our knowledge, there is no research concerning treatment-resistant depressive elderly patients with bupropion. We present a consecutive series of elderly patients (13 subjects: 6 men and 7 women) with major depression. All patients were older than 60 years, with diagnosis of major depressive disorder according to the Diagnostic and Statistical Manual of Mental Disorders, Fourth Edition and were treatment resistant. Patients were treated openly for 6 weeks with bupropion XR (300 mg/d). Efficacy was assessed at baseline and every 3 weeks using the Hamilton Depression Rating Scale, the Montgomery-Asberg Depressive Rating Scale, and the Clinical Global Impression--Severity of Illness Scale. The treatment was generally well tolerated without serious events. In all patients, the average Hamilton Depression Rating Scale scores diminished from 41.1 to 17.2 at the sixth week (P < 0.0001), the Montgomery-Asberg Depressive Rating Scale scores diminished from 44.0 to 19.9 (P < 0.0001), and Clinical Global Impression-Severity of Illness scores diminished from 5.7 to 3.2 (P < 0.0001). Of the 13 patients, 9 patients had marked and very marked improvement, and 4 patients did not demonstrate any mental state change. Treatment-resistant depressive elderly patients positively responded to and tolerated bupropion XR well. This case series demonstrates that bupropion could be a promising alternative therapy for elderly patients with treatment-resistant major depressive disorder. Further randomized controlled studies are necessary.Clinical neuropharmacology 01/2011; 34(1):17-20. DOI:10.1097/WNF.0b013e3182096f5a · 1.84 Impact Factor