Brief Report
Effects of Nortriptyline and Paroxetine on Postural Sway in Depressed Elderly Patients

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Tricyclic antidepressants (TCAs) have previously been found to be related to an increased incidence of falls in elderly persons. Recent pharmacoepidemiologic and nursing home studies have suggested that the risk of falls and fractures in elderly patients receiving selective serotonin reuptake inhibitors (SSRIs) is not different from that of patients receiving TCAs. The authors therefore evaluated postural sway in an older population of depressed patients randomly assigned to treatment with either nortriptyline or paroxetine and did not find any change in postural sway after 6 weeks' treatment with either antidepressant. Further studies with other SSRIs are needed.

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METHODS

The study was conducted on inpatient units and at an outpatient clinic at Western Psychiatric Institute and Clinic, in Pittsburgh, PA. The subjects in the study were participating in a double-blind, randomized comparison of nortriptyline and paroxetine in the treatment of late-life depression. Methods used in patient recruitment, selection criteria, and clinical evaluation have been described in detail elsewhere.27 The selection criteria used were the following: age 60 and older; major

RESULTS

The study group consisted of 42 subjects, randomized to either nortriptyline (n=17) or paroxetine (n=25); most subjects were women (75%). There was no significant difference between the nortriptyline and paroxetine groups in age (73.3±7.7 years and 70.5±6.7 years, respectively), MMSE, CIRS-G, height, and weight (Table 1). At baseline, only one subject was an inpatient, and at Week 6, all subjects were outpatients. The baseline mean Ham-D score was significantly higher in patients in the

DISCUSSION

We examined postural sway before and after antidepressant treatment in a group of ambulatory elderly patients with major depressive disorder randomly assigned to treatment with nortriptyline or paroxetine as part of a prospective double-blind study. We found no significant change in the length of path (L) of center of pressure and the area included in the center of pressure (Ao) after treatment with either nortriptyline or paroxetine, replicating our earlier results in younger subjects.26 Our

CONCLUSIONS

We found no change in postural sway after 6 weeks' treatment with either nortriptyline or paroxetine in elderly depressed subjects in a prospective double-blind study, consistent with the results of an earlier study in younger subjects.26 Our results suggest that the association of falls with antidepressant treatment may not be due to increased postural sway caused by the antidepressant medications. Studies examining the effect of other SSRIs on postural sway are needed.

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  • Cited by (0)

    This work was supported in part by grants MH01509, MH01613, MH52247, MH43832, MH37869, and MH00295 from the National Institute of Mental Health.

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