A differential response to nortriptyline and fluoxetine in melancholic depression: the importance of age and gender.
OBJECTIVE
To consider the impact of age and gender on the antidepressant response to nortriptyline and fluoxetine in melancholic depression.


METHODS
Of 191 depressed patients, 113 met study criteria for melancholia. All patients were randomized to receive either fluoxetine or nortriptyline. Response rates, defined as an improvement of 60% or more on the Montgomery Asberg Depression Rating Scale over 6 weeks of antidepressant treatment on an intention to treat basis, were examined by age, and by age and gender.


RESULTS
Melancholic depressed patients 40 years or older, especially men, had a markedly superior response to nortriptyline compared with fluoxetine. Conversely, melancholic depressed patients, age 18-24 years, especially women, had a markedly superior response to fluoxetine.


CONCLUSIONS
Age and gender appear to be critical variables in understanding differential antidepressant responses to tricyclic antidepressants and selective serotonin reuptake inhibitors in melancholic depression.
Joyce
P R
PR
Department of Psychological Medicine, Christchurch School of Medicine & Health Sciences, PO Box 4345, Christchurch, New Zealand. peter.joyce@chmeds.ac.nz
Mulder
R T
RT
Luty
S E
SE
McKenzie
J M
JM
Rae
A M
AM
D000293:Adolescent; D018759:Adrenergic Uptake Inhibitors / Q000627:therapeutic use*; D000328:Adult; D000367:Age Factors; D018687:Antidepressive Agents, Second-Generation / Q000627:therapeutic use*; D003866:Depressive Disorder / Q000188:drug therapy* / Q000523:psychology; D005260:Female; D005473:Fluoxetine / Q000627:therapeutic use*; D006801:Humans; D016015:Logistic Models; D008297:Male; D009661:Nortriptyline / Q000627:therapeutic use*; D016017:Odds Ratio; D011569:Psychiatric Status Rating Scales; D012737:Sex Factors
D018759:Adrenergic Uptake Inhibitors; D018687:Antidepressive Agents, Second-Generation; D005473:Fluoxetine; D009661:Nortriptyline