A Double-Blind Comparison of Sertraline and Fluoxetine in Depressed Elderly Outpatients

Background: There has been a paucity ofwell-designed studies comparing selective serotonin reuptakeinhibitor (SSRI) medications in the treatment of depression inthe elderly. This multicenter study was designed to examine theefficacy and safety of sertraline and fluoxetine in depressedelderly outpatients. A secondary objective was to examine theeffects of SSRI treatment on quality of life and cognitivefunction.

Method: Two hundred thirty-six outpatients 60years of age and older who met DSM-III-R criteria for majordepressive disorder received 1 week of single-blind placebobefore being randomly assigned to 12 weeks of double-blind,parallel-group treatment with flexible daily doses of eithersertraline (range, 50-100 mg) or fluoxetine (range, 20-40 mg).Primary efficacy measures consisted of the 24-item HamiltonRating Scale for Depression and Clinical Global Impressions scaleratings. Secondary outcome assessments included clinician- andpatient-rated measures of depression symptoms and factors,cognitive functioning, and quality of life, as well as plasmadrug concentrations, which were correlated with clinicalresponse.

Results: Both drugs produced a similarlypositive response on the primary efficacy measures, with 12-weekresponder rates of 73% for sertraline and 71% for fluoxetine.Sertraline-treated patients showed statistically greatercognitive improvement on several measures. Both drugs were safeand well tolerated.

Conclusion: Data indicate that both drugs areeffective antidepressants for the treatment of depressed elderlyoutpatients. Differences in cognitive performance effects deservefurther investigation.