Differential efficacy of escitalopram and nortriptyline on dimensional measures of depression.
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.
Uher
Rudolf
R
Institute of Psychiatry, King's College London, 16 De Crespigny Park, SE5 8AF, London, UK. r.uher@iop.kcl.ac.uk
Maier
Wolfgang
W
Hauser
Joanna
J
Marusic
Andrej
A
Schmael
Christine
C
Mors
Ole
O
Henigsberg
Neven
N
Souery
Daniel
D
Placentino
Anna
A
Rietschel
Marcella
M
Zobel
Astrid
A
Dmitrzak-Weglarz
Monika
M
Petrovic
Ana
A
Jorgensen
Lisbeth
L
Kalember
Petra
P
Giovannini
Caterina
C
Barreto
Mara
M
Elkin
Amanda
A
Landau
Sabine
S
Farmer
Anne
A
Aitchison
Katherine J
KJ
McGuffin
Peter
P
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
D000928:Antidepressive Agents; D015283:Citalopram; D009661:Nortriptyline