Paroxetine versus amitriptyline for treatment of depression associated with rheumatoid arthritis

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J Rheumatol 2000 Dec;27(12):2791-7

Paroxetine versus amitriptyline for treatment of depression associated with

rheumatoid arthritis: a randomized, double blind, parallel group study.

Bird H, Broggini M

Clinical Pharmacology, Unit, Chapel Allerton Hospital, Leeds, United Kingdom.

OBJECTIVE: To compare the efficacy and tolerability of paroxetine (a selective

serotonin reuptake inhibitor) with that of amitriptyline (a tricyclic

antidepressant) in the treatment of depression in 191 patients with rheumatoid

arthritis (RA). METHODS: A randomized, double blind, double dummy, parallel

group study. A placebo washout period of 3-7 days was followed by an 8 week

active treatment phase during which patients received either paroxetine (20-40

mg daily) or amitriptyline (75-150 mg daily). The primary efficacy variable was

the change from baseline in Montgomery Asberg Depression Rating Scale score at

endpoint. RESULTS: Paroxetine was as effective as amitriptyline for the

treatment of depression, with similar improvements in RA associated pain and

disability also seen in both groups. However, paroxetine was better tolerated

than amitriptyline, with an overall frequency of adverse experiences of 56.4%

and 67.7% in the 2 groups, respectively. The frequency of anticholinergic

adverse experiences was much lower in the paroxetine treatment group (18.1% vs

43.8% taking amitriptyline) and paroxetine treated patients also experienced

fewer severe (16.0% vs 21.9%), serious nonfatal (0% vs 4.2%), and drug related

adverse experiences (12.8% vs 29.2%). CONCLUSION: Tolerability is an important

consideration in this patient population, which is largely composed of elderly

patients who are taking additional medications for RA. Paroxetine shows a number

of advantages in the management of depression comorbid with RA.

PMID: 11128665, UI: 21011281