Differential efficacy of escitalopram and nortriptyline on dimensional measures of depression

作者：Uher Rudolf^*; Maier Wolfgang; Hauser Joanna; Marusic Andrej; Schmael Christine; Mors Ole; Henig**erg Neven; Souery Daniel; Placentino Anna; Rietschel Marcella; Zobel Astrid; Dmitrzak Weglarz Monika; Petrovic Ana; Jorgensen Li**eth; Kalember Petra; Giovannini Caterina; Barreto Mara; Elkin Amanda; Landau Sabine; Farmer Anne; Aitchison Katherine J; McGuffin Peter

来源：The British Journal of Psychiatry, 2009, 194(3): 252-259.

DOI：10.1192/bjp.bp.108.057554

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.
Aims
To test the hypothesis that escitalopram and nortriptyline differ in their effects on observed mood, cognitive and neurovegetative symptoms of depression.
Method
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.

• 出版日期2009-3
• 单位上海市精神卫生中心