Venlafaxine versus nortriptyline in the treatment of elderly depressed inpatients: a randomised, double-blind, controlled trial.

Background: The majority of the trials in the elderly are outpatient trials which excluded psychotic patients and patients with common comorbid physical disorders. Consequently information is lacking about the more complex cases of elderly depressed patients, as found in inpatient wards.

Objective: To evaluate the effectiveness of two antidepressants, venlafaxine and nortriptyline, in a clinically representative sample of elderly depressed inpatients.

Method: A 12-week, double blind, randomised, controlled trial in 81 elderly inpatients from one centre. All patients fulfilled DSM-IV criteria for major depression and were assessed using the Montgomery Asberg Depression Rating Scale, the Hamilton Depression Rating Scale, the Geriatric Depression Scale, the Clinical Global Improvement and the Symptom, sign, and Side-effect Checklist.

Results: Overall, remission was achieved by 26 (32.1%) of the patients. There was no statistically significant difference in the number of patients achieving remission on the MADRS between venlafaxine (11 out of 40 patients) and nortriptyline (15 out of 41 patients; p = 0.381) or in any of the secondary outcome variables. The number and severity of side-effects was not statistically different between both treatment groups and most side effects were mild or moderate in intensity.

Conclusions: In elderly inpatients with severe depression, venlafaxine and nortriptyline appeared to be equally effective and equally well tolerated.