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October 23, 1996

Initial Choice of Antidepressant Therapy in Primary Care

Author Affiliations

Hôpital René Muret-Bigottini Sevran, France

JAMA. 1996;276(16):1301. doi:10.1001/jama.1996.03540160023024

To the Editor.  —Dr Simon and colleagues1 reported a randomized trial comparing the effectiveness, safety, and cost of fluoxetine vs tricyclic agents as the initial antidepressant choice in primary care setting. They concluded that these therapeutic approaches provided similar outcomes and that no clear guidance on the initial drug selection can be drawn from the study. However, we believe that their conclusions should not be directly applied to elderly patients with depression because their trial included only a small number of patients older than 65 years (7% of the total sample of 536 patients).Depression is recognized as a major public health problem in later life since the disease is highly prevalent in the elderly (affecting 10% to 15% of the general population older than 65 years) and markedly alters the quality of life.2 It has been suggested that older patients with depression might potentially benefit more than