• O V Forlenza, A Stoppe Júnior, E S Hirata, and R C Ferreira.
• Neurosciences Laboratory (LIM-27), Institute of Psychiatry, Hospital das Clínicas, Faculdade de Medicina, Universidade de São Paulo, Brazil.
• Sao Paulo Med J. 2000 Jul 6; 118 (4): 9910499-104.

ContextMost double-blind studies of efficacy and tolerability of sertraline as compared to tricyclics in the treatment of late-life major depression have used amitriptyline as a standard, leading to the inevitable conclusion that the former drug is better tolerated than the latter, with both being equally efficacious.ObjectiveTo compare the antidepressant efficacy and tolerability of sertraline (50 mg/day) and imipramine (150 mg/day) in the first 6 weeks of the treatment of major depression in the elderly.DesignA randomized double-blind parallel study with 6 weeks of follow-up.SettingThe psychogeriatric clinic at the Institute of Psychiatry, Hospital das Clínicas, Faculty of Medicine of the University of São Paulo.Participants55 severe and moderately depressed non-demented outpatients aged 60 years or more.InterventionPatients were assigned to sertraline 50 mg/day or imipramine 150 mg/day.Main MeasurementsCAMDEX interview. Psychiatric diagnosis followed the guidelines for "Major Depressive Episode" according to DSM-IV criteria. Severity of symptoms was evaluated using the "CGI" and "MADRS" scales. Cognitive state was assessed using the Mini-Mental State Examination. Side effects were assessed using the "Safetee-Up" schedule.ResultsBoth groups had a significant decrease in depressive symptoms according to the MADRS scores after 6 weeks of treatment (P = 0.01). No significant differences between groups were detected regarding treatment outcome (t = 0.4; P = 0.7). Although the dropout rate was greater in the imipramine group, the overall tolerability among patients who completed the 6-week trial was similar in both test groups.ConclusionsBoth sertraline and imipramine exhibited good efficacy and an acceptable side-effect profile for elderly depressed patients after 6 weeks of antidepressant treatment.

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