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Differential efficacy of escitalopram and nortriptyline on dimensional measures of depression

  • Rudolf Uher (a1), Wolfgang Maier (a2), Joanna Hauser (a3), Andrej Marušič (a4), Christine Schmael (a5), Ole Mors (a6), Neven Henigsberg (a7), Daniel Souery (a8), Anna Placentino (a9), Marcella Rietschel (a5), Astrid Zobel (a2), Monika Dmitrzak-Weglarz (a3), Ana Petrovic (a4), Lisbeth Jorgensen (a10), Petra Kalember (a7), Caterina Giovannini (a9), Mara Barreto (a8), Amanda Elkin (a1), Sabine Landau (a1), Anne Farmer (a1), Katherine J. Aitchison (a1) and Peter McGuffin (a1)...
Abstract
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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Copyright
Corresponding author
Correspondence: Rudolf Uher, P080 SGDP, Institute of Psychiatry, 16 De Crespigny Park, SE5 8AF, London, UK. Email: r.uher@iop.kcl.ac.uk
Footnotes
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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.

Footnotes
References
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Differential efficacy of escitalopram and nortriptyline on dimensional measures of depression

  • Rudolf Uher (a1), Wolfgang Maier (a2), Joanna Hauser (a3), Andrej Marušič (a4), Christine Schmael (a5), Ole Mors (a6), Neven Henigsberg (a7), Daniel Souery (a8), Anna Placentino (a9), Marcella Rietschel (a5), Astrid Zobel (a2), Monika Dmitrzak-Weglarz (a3), Ana Petrovic (a4), Lisbeth Jorgensen (a10), Petra Kalember (a7), Caterina Giovannini (a9), Mara Barreto (a8), Amanda Elkin (a1), Sabine Landau (a1), Anne Farmer (a1), Katherine J. Aitchison (a1) and Peter McGuffin (a1)...
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