Antidepressive treatment with amitriptyline and paroxetine: effects on saliva cortisol concentrations.
With regard to the course of basal human hypothalamus-pituitary-adrenal (HPA) system activity, there is a lack of data for comparing different classes of antidepressants. Ninety-four patients were included in a study comparing standardized treatment with paroxetine (PAROX) and amitriptyline (AMI) after a drug-free period of at least 6 days. Saliva for measurement of cortisol concentrations was obtained daily at 0800, 1600, and 2200 during the 6 days of drug-free washout and 35 days of active treatment. The course of HPA system activity and psychopathology, as assessed by the Hamilton Depression Scale, was compared by means of repeated-measurement analyses of variance (ANOVA-rm). Only AMI responders-not PAROX responders or nonresponders to either antidepressant-had a significant decline in saliva cortisol concentrations. In hypercortisolemically depressed patients, treatment with AMI may be preferable to PAROX in order to lower HPA system activity.
Deuschle
Michael
M
Central Institute of Mental Health, Mannheim, and dagger Department of Psychiatry, Free University of Berlin, Berlin, Germany. deuschle@as200.zi-mannheim.de
Hamann
Bettina
B
Meichel
Cornelia
C
Krumm
Bertram
B
Lederbogen
Florian
F
Kniest
Anja
A
Colla
Michael
M
Heuser
Isabella
I
D000639:Amitriptyline / Q000494:pharmacology* / Q000627:therapeutic use; D000928:Antidepressive Agents / Q000494:pharmacology* / Q000627:therapeutic use; D003865:Major Depressive Disorder / Q000188:drug therapy* / Q000503:physiopathology / Q000523:psychology; D005260:Female; D006801:Humans; D006854:Hydrocortisone / Q000032:analysis*; D007030:Hypothalamo-Hypophyseal System / Q000187:drug effects / Q000503:physiopathology; D008297:Male; D008875:Middle Aged; D017374:Paroxetine / Q000494:pharmacology* / Q000627:therapeutic use; D010913:Pituitary-Adrenal System / Q000187:drug effects / Q000503:physiopathology; D011569:Psychiatric Status Rating Scales; D012463:Saliva / Q000737:chemistry*; D016896:Treatment Outcome
D000928:Antidepressive Agents; D000639:Amitriptyline; D017374:Paroxetine; D006854:Hydrocortisone