Paroxetine and Fluoxetine Effects On Mood and Cognitive Functions in Depressed Nondemented Elderly Patients
Abstract
BACKGROUND: A large proportion of the elderly population complains of depressive symptoms. The ideal antidepressant for these patients, who often suffer from numerous concomitant diseases, should not worsen their cognitive functions and should be free of contraindications. METHOD: To assess the effects of 2 selective serotonin reuptake inhibitors on cognitive functions in elderly depressed patients (ICD-10 criteria), we conducted a double-blind, randomized, parallel-group, multicenter study comparing paroxetine (20-40 mg daily) and fluoxetine (20-60 mg daily) treatment for 1 year. Cognitive performance was evaluated by means of the Buschke Selective Reminding Test, the Blessed Information and Memory Test, the Clifton Assessment Schedule, the Cancellation Task Test, and the Wechsler Paired Word Test; the Hamilton Rating Scale for Depression (HAM-D) and the Clinical Anxiety Scale were administered to assess the course of depressive and anxiety symptoms, respectively. RESULTS: 242 patients were enrolled (mean +/- SD age = 75.4 +/- 6.6 years). During the study, no deterioration of cognition was observed; on the contrary, most of the tested cognitive functions improved. Good antidepressant efficacy was maintained for over 1 year with both drugs, based on the percentage of responders to treatment (patients achieving a HAM-D total score < 10; 60%). Both drugs showed a good tolerability and safety profile. CONCLUSION: The 2 antidepressants proved to be suitable for the long-term treatment of depression in the elderly and to be devoid of detrimental effects on the tested cognitive functions.
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Treatment with selective serotonin reuptake inhibitors has resulted in improved attention, memory, and learning in depression.
“Treatment with selective serotonin reuptake inhibitors (SSRIs) has resulted in improved attention, memory, and learning [14]”
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ResultInfluentialGudayol‐Ferré, E., Herrera‐Guzmán, I., Camarena, B., Cortés‐Penagos, C., Herrera‐Abarca, J. E., Martínez‐Medina, P., Asbún‐Bojalil, J., Lira‐Islas, Y., Reyes‐Ponce, C., & Guàrdia‐Olmos, J. (2012) · Human Psychopharmacology Clinical and Experimental · doi:10.1002/hup.2267 · Cited by 15 · see citing works
“Several works have likewise proved that chronic treatment with AD improves the neuropsychological alterations of MDD (Battista-Cassano et al., 2002; Constant et al., 2005; Herrera-Guzmán et al., 2009, 2010a, 2010b).”
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“This study did not find cognitive decline with the use of paroxetine and fluoxetine.(38) The current study used real-world data and found that there is no significant difference in cognition across the 2 treatment groups.”
BackgroundHerrera‐Guzmán, I., Gudayol‐Ferré, E., Jarne-Esparcia, A. J., Herrera‐Abarca, J. E., Herrera-Guzmán, D., Peró, M., & Guàrdia‐Olmos, J. (2009) · The European Journal of Psychiatry · doi:10.4321/s0213-61632009000100001 · Cited by 11 · see citing works
Effects of sertraline, duloxetine, vortioxetine, and idazoxan in the rat affective bias test
Refsgaard, L. K., Haubro, K., Pickering, D. S., Stuart, S. A., Robinson, E. S. J., & Andreasen, J. T. (2016) · Psychopharmacology · doi:10.1007/s00213-016-4407-6 · Cited by 12 · see citing works
“, 2013) and conventional antidepressants (Raskin et al., 2007; Greer et al., 2014; Katona et al., 2012; Herrera-Guzmán et al., 2009; Gallassi et al., 2006; Cassano et al., 2002; CulangReinlieb et al., 2012) in humans, although some inconsistencies in the literature exist (Ferguson et al.”
BackgroundInhibition of TNBC Cell Growth by Paroxetine: Induction of Apoptosis and Blockage of Autophagy Flux
Huang, Q., Wu, M., Pu, Y., Zhou, J., Zhang, Y., Li, R., Xia, Y., Zhang, Y., & Ma, Y. (2024) · Cancers · doi:10.3390/cancers16050885 · Cited by 12 · see citing works
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The role of encoding strategies in contextual memory deficits in patients with bipolar disorder
Corrêa, M. S., da Silveira, E. M. S., de Lima, D. B., Balardin, J. B., Walz, J. C., Kapczinski, F. P., & Bromberg, E. (2014) · Neuropsychological Rehabilitation · doi:10.1080/09602011.2014.969281 · Cited by 10 · see citing works
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“In contrast, we could not detect in MDD patients an improvement in their attention and working memory as reported by others (Cassano et al., 2002; Jaeger et al., 2006).”
ResultSecond-Generation Antidepressants in the Pharmacologic Treatment of Adult Depression
Gartlehner, G., Hansen, R. A., Morgan, L. C., Thaler, K. J., Lux, L. J., Noord, M. V., Mager, U., Gaynes, B. N., Thieda, P., Strobelberger, M., et al. (2011) · Cited by 8 · see citing works
Krzysztoforska, K., Piechal, A., Wojnar, E., Blecharz‐Klin, K., Pyrzanowska, J., Joniec‐Maciejak, I., Krzysztoforski, J., & Widy‐Tyszkiewicz, E. (2023) · Nutrients · doi:10.3390/nu15030625 · Cited by 7 · see citing works
“In turn, studies of selective serotonin reuptake inhibitors have shown that enhanced serotonergic transmission improves the performance of many declarative memory tasks in both animals and humans, prevents the development of pharmacologically induced amnesia, and improves memory consolidation and retrieval in mice [39…”
BackgroundInternational Dosage Differences in Fluoxetine Clinical Trials
Patten, S. B., Cipriani, A., Brambilla, P., Nosè, M., & Barbui, C. (2005) · The Canadian Journal of Psychiatry · doi:10.1177/070674370505000107 · Cited by 7 · see citing works
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Gartlehner, G., Hansen, R. A., Kahwati, L. C., Lohr, K. N., Gaynes, B. N., & Carey, T. (2006) · Cited by 4 · see citing works
Klinisch-Neuropsychologische Aspekte der Therapie mit Psychopharmaka
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Working Memory in Patients with Major Depressive Disorder
Kaneda, Y. (2012) · Psychology · doi:10.4236/psych.2012.329115 · Cited by 3 · see citing works
“Cassano et al. (2002), in their double-blind, randomized, parallel-group, multicenter study comparing paroxetine and fluoxetine treatment for 1 year, found that improvement, rather than deterioration, was observed in most of the tested cognitive functions.”
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Adverse Effects of Pharmacological Treatments of Major Depression in Older Adults
Sobieraj, D. M. (2019) · doi:10.23970/ahrqepccer215 · Cited by 3 · see citing works
Shi, H., Li, Q., Hu, F., Liu, Y., & Wang, K. (2025) · Translational Psychiatry · doi:10.1038/s41398-025-03291-w · Cited by 2 · see citing works
National patterns of paroxetine use among US Medicare patients from 2015–2020
Cavanah, L. R., Goldhirsh, J. L., Huey, L. Y., & Piper, B. J. (2024) · Frontiers in Psychiatry · doi:10.3389/fpsyt.2024.1399493 · Cited by 2 · see citing works
Medications and Cognition in Older Adults
Caporaso, G. L. (2012) · Springer eBooks · doi:10.1007/978-1-4614-3106-0_7 · Cited by 2 · see citing works
Liu, S., Ma, X., Yin, M., Zhu, H., Zhao, Y., Nelson, B., Jia Liu, B., & Jia, H. (2014) · Chinese Science Bulletin · doi:10.1007/s11434-014-0198-5 · Cited by 2 · see citing works
- Authors
- Cassano, G. B., Puca, F., Scapicchio, P. L., Trabucchi, M., & Italian Study Group on Depression in Elderly Patients
- Affiliations
- University of Pisa (IT)
- Venue
- The Journal of Clinical Psychiatry
- Publisher
- Physicians Postgraduate Press, Inc
- Published
- 2002-05-15
- Volume
- 63
- Issue
- 5
- Pages
- 396-402
- ISSN
- 0160-6689 (ISSN-L)
- OpenAlex
- W2046119291
- Cited by
- 121
- References
- 0
- Citations by year
- 2025: 3 · 2024: 4 · 2023: 3 · 2022: 5 · 2021: 1 · 2020: 1 · 2019: 7 · 2018: 2 · 2017: 1 · 2016: 2 · 2015: 4 · 2014: 9 · 2013: 7 · 2012: 8
- FWCI
- 4.24
- Type
- journal article
- Language
- en
- Open access
- closed
- Locations
- The Journal of Clinical Psychiatry (publishedVersion)
- PubMed (publishedVersion)
- Topics
- Health Sciences › Medicine › Pharmacology › Treatment of Major Depression
- Health Sciences › Medicine › Psychiatry and Mental health › Dementia and Cognitive Impairment Research
- Social Sciences › Psychology › Experimental and Cognitive Psychology › Anxiety, Depression, Psychometrics, Treatment, Cognitive Processes
- Keywords
- paroxetine, fluoxetine, selective serotonin reuptake inhibitors, geriatric depression, cognitive function, long-term antidepressant treatment, antidepressant efficacy, safety and tolerability, anxiety symptoms
- MeSH terms
- Affect, Age Factors, Aged, Ambulatory Care, Anxiety Disorders, Cognition, Depressive Disorder, Double-Blind Method, Female, Fluoxetine, Humans, Male, Psychiatric Status Rating Scales, Survival Analysis, Treatment Outcome, Selective Serotonin Reuptake Inhibitors, Paroxetine
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