Continuation and Maintenance Pharmacotherapy in Geriatric Depression: An Open-Trial Comparison of Paroxetine and Nortriptyline in Patients Older Than 70 Years

We present preliminary data on the efficacy of paroxetine, as compared with nortriptyline, in preventing or delaying relapse and recurrence of major depression in elderly patients. Following doubleblind, acute-phase pharmacotherapy, 25 patients (mean age = 72.5 years) began open-trial continuation treatment with paroxetine (mean dose = 24.5 mg/day), and 15 patients (mean age = 77.5 years) received nortriptyline (mean dose = 51.3 mg/day; mean blood level = 85.5 ng/mL). Over an 18-month period, paroxetine and nortriptyline have shown comparable efficacy in preventing or delaying relapse and recurrence, with 80% to 90% of patients remaining well. These data suggest that paroxetine holds promise for long-term maintenance treatment in patients in their 70s and older with depression; however, further controlled evaluation is necessary.