Comparison of Paroxetine and Maprotiline in Minor Depression

Whilst the efficacy of paroxetine has been demonstrated in MDD, its clinical utility in minor depression has not been established. This study assesses the antidepressant efficacy of paroxetine in patients meeting RDC criteria for minor depression. All patients scored 13 points on the 17-item Hamilton Depression Rating Scale (HAMD) at baseline. After a 3 day washout period, patients were randomised to receive paroxetine 20–40mg/day or maprotiline 100-150mg/day, dose being titrated according to clinical response after 3 weeks treatment at the lower doses. Assessments conducted at baseline (day 0) and at weekly intervals for 6 weeks included the 17-item HAMD, the Montgomery-Asberg Depression Rating Scale (MADRS), and the physicians Clinical Global Impression (CGI). 245 patients (126 paroxetine and 119 maprotiline) were evaluable on an intent to treat basis. The two groups were well matched on all major demographic variables. For the changes from baseline on the HAMD total, the paroxetine group had significantly greater mean reductions at weeks 3-6 and end-point (p≤ 0.04). This result was reinforced by the numbers of patients achieving a 50% reduction in HAMD total at weeks 4 to 6: week 4 - 79% paroxetine, 67% maprotiline; week 6: −91% paroxetine, 80% maprotiline. The robustness of these findings was further underscored by similar results for the MADRS and the CGI. These results indicate the superior efficacy of paroxetine compared to maprotiline in minor depression.