Bupropion Sustained Release Versus Paroxetine for the Treatment of Depression in the Elderly

Department of Psychiatry, George Washington University, Washington, DC 20037, USA.
The Journal of Clinical Psychiatry (Impact Factor: 5.5). 04/2000; 61(3):196-202. DOI: 10.4088/JCP.v61n0309
Source: PubMed


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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    • "Finally, three trials were identified as suitable for EVITA evaluation. In a six-week study of 100 depressed patients [24], bupropion did not show superiority with respect to the Hamilton-scale (HAMD-17) over paroxetin, an antidepressant acceptable as established therapy. In two three-arm studies, only available online in the GSK Clinical Trial Register [25,26], bupropion was compared to placebo and venlafaxin using the "Montgomery-Asberg Depression Rating Scale"(MADRS) measuring changes after 8 or 10 weeks. "
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    • "Drug effects on salivary glands: dry mouth C Scully to smoke, but dry mouth is common (Zwar and Richmond, 2002). A comparison of bupropion sustained release (SR) with the SSRI paroxetine in the treatment of major depression showed headache, insomnia, dry mouth, agitation, dizziness, and nausea in >10% of patients in both groups (Weihs et al, 2000). Dry mouth occurred more frequently with bupropion SR (19%) than with the SSRI sertraline (14%) or placebo (12%), although the differences were not significant (Croft et al, 1999). "
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