A Post Hoc Comparison of Paroxetine and Nortriptyline for Symptoms of Traumatic Grief
J Clin Psychiatry 1998;59(5):241-245
© Copyright 2014 Physicians Postgraduate Press, Inc.
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Background: This report presents the results of
an open-trial pilot study of paroxetine for symptoms of traumatic
grief, compared with the effects of nortriptyline in an archival
Method: Data are presented on 15 subjects (4
men, 11 women), ranging in age from 40 to 79 years (mean age=57
years), who experienced the loss of a spouse (N=8), child (N=5),
grandchild (N=1), or parent (N=1). Subjects were required to have
a baseline score on the Inventory of Complicated Grief (ICG) of
ž20. Treatment with paroxetine began at a median of 17
months (range, 6_139 months) after the loss. Paroxetine-treated
subjects received a psychotherapy tailored for traumatic grief.
Depressive symptoms were assessed by using the Hamilton Rating
Scale for Depression (HAM-D). The ICG and the HAM-D were
administered weekly over 4 months of paroxetine treatment (median
dose=30 mg/day). The group receiving paroxetine were then
compared with a group (N=22) participating in a separate trial of
nortriptyline (median dose=77.5 mg/day) for treatment of
bereavement-related major depressive episodes.
Results: Level of traumatic grief symptoms (ICG)
decreased by 53%, and depression ratings (HAM-D) decreased by 54%
in paroxetine-treated subjects. Nortriptyline showed clinical
effects comparable to those of paroxetine.
Conclusion: Paroxetine may be an effective agent
in the treatment of traumatic grief symptoms. A comparison of the
paroxetine-treated group with a nortriptyline-treated group
suggests that both agents have comparably beneficial effects on
the symptoms of traumatic grief (as well as those of depression).
However, the higher rate of diagnostic comorbidity in the
paroxetine-treated group, together with the greater chronicity of
their symptoms and the greater safety of paroxetine in overdose,
leads us to favor paroxetine over nortriptyline for traumatic
grief symptoms in general psychiatric practice. Further
controlled evaluation of paroxetine for traumatic grief is