A Post Hoc Comparison of Paroxetine and Nortriptyline for Symptoms of Traumatic Grief

Background: This report presents the results ofan open-trial pilot study of paroxetine for symptoms of traumaticgrief, compared with the effects of nortriptyline in an archivalcontrast group.

Method: Data are presented on 15 subjects (4men, 11 women), ranging in age from 40 to 79 years (mean age=57years), who experienced the loss of a spouse (N=8), child (N=5),grandchild (N=1), or parent (N=1). Subjects were required to havea baseline score on the Inventory of Complicated Grief (ICG) ofž20. Treatment with paroxetine began at a median of 17months (range, 6_139 months) after the loss. Paroxetine-treatedsubjects received a psychotherapy tailored for traumatic grief.Depressive symptoms were assessed by using the Hamilton RatingScale for Depression (HAM-D). The ICG and the HAM-D wereadministered weekly over 4 months of paroxetine treatment (mediandose=30 mg/day). The group receiving paroxetine were thencompared with a group (N=22) participating in a separate trial ofnortriptyline (median dose=77.5 mg/day) for treatment ofbereavement-related major depressive episodes.

Results: Level of traumatic grief symptoms (ICG)decreased by 53%, and depression ratings (HAM-D) decreased by 54%in paroxetine-treated subjects. Nortriptyline showed clinicaleffects comparable to those of paroxetine.

Conclusion: Paroxetine may be an effective agentin the treatment of traumatic grief symptoms. A comparison of theparoxetine-treated group with a nortriptyline-treated groupsuggests that both agents have comparably beneficial effects onthe symptoms of traumatic grief (as well as those of depression).However, the higher rate of diagnostic comorbidity in theparoxetine-treated group, together with the greater chronicity oftheir symptoms and the greater safety of paroxetine in overdose,leads us to favor paroxetine over nortriptyline for traumaticgrief symptoms in general psychiatric practice. Furthercontrolled evaluation of paroxetine for traumatic grief isnecessary.