title: Differential efficacy of escitalopram and nortriptyline on dimensional measures of depression.
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.
  
  
  OBJECTIVE
  To test the hypothesis that escitalopram and nortriptyline differ in their effects on observed mood, cognitive and neurovegetative symptoms of depression.
  
  
  METHODS
  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-Asberg 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.
authors.affiliation: Institute of Psychiatry, King's College London, 16 De Crespigny Park, SE5 8AF, London, UK. r.uher@iop.kcl.ac.uk
authors.forename: Rudolf
authors.initials: R
authors.lastname: Uher
authors.forename: Wolfgang
authors.initials: W
authors.lastname: Maier
authors.forename: Joanna
authors.initials: J
authors.lastname: Hauser
authors.forename: Andrej
authors.initials: A
authors.lastname: Marusic
authors.forename: Christine
authors.initials: C
authors.lastname: Schmael
authors.forename: Ole
authors.initials: O
authors.lastname: Mors
authors.forename: Neven
authors.initials: N
authors.lastname: Henigsberg
authors.forename: Daniel
authors.initials: D
authors.lastname: Souery
authors.forename: Anna
authors.initials: A
authors.lastname: Placentino
authors.forename: Marcella
authors.initials: M
authors.lastname: Rietschel
authors.forename: Astrid
authors.initials: A
authors.lastname: Zobel
authors.forename: Monika
authors.initials: M
authors.lastname: Dmitrzak-Weglarz
authors.forename: Ana
authors.initials: A
authors.lastname: Petrovic
authors.forename: Lisbeth
authors.initials: L
authors.lastname: Jorgensen
authors.forename: Petra
authors.initials: P
authors.lastname: Kalember
authors.forename: Caterina
authors.initials: C
authors.lastname: Giovannini
authors.forename: Mara
authors.initials: M
authors.lastname: Barreto
authors.forename: Amanda
authors.initials: A
authors.lastname: Elkin
authors.forename: Sabine
authors.initials: S
authors.lastname: Landau
authors.forename: Anne
authors.initials: A
authors.lastname: Farmer
authors.forename: Katherine J
authors.initials: KJ
authors.lastname: Aitchison
authors.forename: Peter
authors.initials: P
authors.lastname: McGuffin
mesh_terms: D000293:Adolescent; D000328:Adult; D000368:Aged; D000928:Antidepressive Agents / Q000627:therapeutic use*; D015283:Citalopram / Q000008:administration & dosage*; D003866:Depressive Disorder / Q000188:drug therapy* / Q000523:psychology; D005260:Female; D006801:Humans; D008297:Male; D008875:Middle Aged; D009661:Nortriptyline / Q000008:administration & dosage*; D011569:Psychiatric Status Rating Scales; D016896:Treatment Outcome; D055815:Young Adult
chemical_list: D000928:Antidepressive Agents; D015283:Citalopram; D009661:Nortriptyline