The British Journal of Psychiatry (2009) 194: 252-259. doi: 10.1192/bjp.bp.108.057554
© 2009 The Royal College of Psychiatrists
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Differential efficacy of escitalopram and nortriptyline on dimensional measures of depression

Rudolf Uher, PhD

Institute of Psychiatry, King's College London, UK

Wolfgang Maier, MD

Department of Psychiatry, University of Bonn, Germany

Joanna Hauser, MD

Laboratory of Psychiatric Genetics, Poznan University of Medical Sciences, Poland

Andrej Marusic, PhD

Institute of Public Health, Ljubljana, Slovenia

Christine Schmael, MD

Central Institute of Mental Health, Division of Genetic Epidemiology in Psychiatry, Mannheim, Germany

Ole Mors, PhD

Centre for Psychiatric Research, Aarhus University Hospital, Risskov, Denmark

Neven Henigsberg, MD

Croatian Institute for Brain Research, Medical School, University of Zagreb, Croatia

Daniel Souery, PhD

Université Libre de Bruxelles, Erasme Academic Hospital, Department of Psychiatry, Brussels, Belgium

Anna Placentino, PsyD

Biological Psychiatry Unit and Dual Diagnosis ward IRCCS, Centro San Giovanni di Dio, FBF, Brescia, Italy

Marcella Rietschel, MD

Central Institute of Mental Health, Division of Genetic Epidemiology in Psychiatry, Mannheim, Germany

Astrid Zobel, MD

Department of Psychiatry, University of Bonn, Germany

Monika Dmitrzak-Weglarz, PhD

Laboratory of Psychiatric Genetics, Poznan University of Medical Sciences, Poland

Ana Petrovic, MD

Institute of Public Health, Ljubljana, Slovenia

Lisbeth Jorgensen, MSc Psych

Centre for Psychiatric Research and Mood Disorders Research Unit, Aarhus University Hospital, Risskov, Denmark

Petra Kalember, MD

Croatian Institute for Brain Research, Medical School, University of Zagreb, Croatia

Caterina MD Giovannini, PsyD

Mara Barreto, MD

Biological Psychiatry Unit and Dual Diagnosis ward IRCCS, Centro San Giovanni di Dio, FBF, Brescia, Italy

Amanda Elkin, MRCPsych

Université Libre de Bruxelles, Erasme Academic Hospital, Department of Psychiatry, Brussels, Belgium

Sabine Landau, PhD, Anne Farmer, MD, FRCPsych, Katherine J. Aitchison, PhD and Peter McGuffin, PhD, FRCP, FRCPsych

Institute of Psychiatry, King's College London, UK.

Correspondence: Rudolf Uher, P080 SGDP, Institute of Psychiatry, 16 De Crespigny Park, SE5 8AF, London, UK. Email: r.uher{at}iop.kcl.ac.uk

Declaration of interest

S.L. owns shares in GlaxoSmithKline. N.H. participated in clinical trials sponsored by pharmaceutical companies including GlaxoSmithKline and Lundbeck. A.F., P.M. and K.J.A. have received consultancy fees and honoraria for participating in expert panels from pharmaceutical companies including Lundbeck and GlaxoSmithKline. Funding detailed in Acknowledgements.

Background

Tricyclic antidepressants and serotonin reuptake inhibitors are considered to be equally effective, but differences may have been obscured by internally inconsistent measurement scales and inefficient statistical analyses.

Aims

To test the hypothesis that escitalopram and nortriptyline differ in their effects on observed mood, cognitive and neurovegetative symptoms of depression.

Method

In a multicentre part-randomised open-label design (the Genome Based Therapeutic Drugs for Depression (GENDEP) study) 811 adults with moderate to severe unipolar depression were allocated to flexible dosage escitalopram or nortriptyline for 12 weeks. The weekly Montgomery–Åsberg Depression Rating Scale, Hamilton Rating Scale for Depression, and Beck Depression Inventory were scored both conventionally and in a more novel way according to dimensions of observed mood, cognitive symptoms and neurovegetative symptoms.

Results

Mixed-effect linear regression showed no difference between escitalopram and nortriptyline on the three original scales, but symptom dimensions revealed drug-specific advantages. Observed mood and cognitive symptoms improved more with escitalopram than with nortriptyline. Neurovegetative symptoms improved more with nortriptyline than with escitalopram.

Conclusions

The three symptom dimensions provided sensitive descriptors of differential antidepressant response and enabled identification of drug-specific effects.


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