Aventyl Versus Prozac for Treatment of Major Depression

The psychotropic medication Aventyl (nortriptyline) belongs to the class of drugs known as tricyclic antidepressants. This class of medications has been overshadowed by the newer selective serotonin reuptake inhibitors (SSRIs). These newer medications boast fewer side effects while being just as effective as the older tricyclics. Prozac (fluoxetine) is the most commonly prescribed drug in the SSRI class. Worldwide, depression is a major public health issue and is a frequent cause of disability or poor quality of life. Countless studies have been conducted to determine which medication and treatment approach is most effective in particular situations. Because depression has so many root causes and outward manifestations, there is no easy solution to the disease. Complete remission is, of course, the ultimate goal but cannot be achieved overnight.

An outpatient study in Iran compared Aventyl with Prozac in terms of safety, effectiveness, and patient satisfaction. The study originally recruited 120 participants, but 23 of these dropped out prematurely. Whether or not these dropouts occurred because of side effects or poor response to medication is unknown. Ultimately, 97 patients provided usable data. Half were prescribed Aventyl while the rest received Prozac for a period of 6 months. At the beginning of the study, all participants were scored on a standard rating system for depression: the Beck depression inventory. A score of 30 or higher indicates possible severe depression. The average for the entire group was around 33.

The results showed measurably better improvement in the Prozac group than the Aventyl group. Patients experienced an average decline in depression scores of about 17 points, while the Aventyl group only saw a 13-point decline. Age and sex had no statistically significant effect on the results. It’s unclear whether that four-point difference between the two groups is clinically important. However, those receiving Aventyl did experience a wider array of side effects, including headache, dizziness, drowsiness, and aggression. Nausea was the only noteworthy side effect of Prozac. Patients were also asked to rate their satisfaction with treatment, and these subjective ratings are perhaps most informative of all. Nearly 20% of Aventyl patients were “dissatisfied” with treatment, as opposed to only about 10% for Prozac.

According to the current study, Prozac appears to be a better choice, in general, than Aventyl for treating major depression. Sex, age, and educational background had no effect on outcomes. Nevertheless, Aventyl still has significant usefulness with conditions other than major depression. As for treating depression, it’s important to select treatment on a case-by-case basis, rather than trusting in sweeping generalizations. Patient monitoring is likewise critical during treatment to assess whether an approach is working well or needs reconsidering.


  1. Hashemi, S. N., Ghafarian Shirazi, H. R., Mohammadi, A., Zadeh-Bagheri, G. H., Noorian, K. H., Malekzadeh, M. (2012). Nortriptyline versus fluoxetine in the treatment of major depressive disorder: a six-month, double-blind trial. Clinical Pharmacology: Advances and Applications, 4, 1-6.
  2. PubMed Health. (n.d.). National Center for Biotechnology Information. Nortriptyline. Retrieved March 27, 2012, from http://www.ncbi.nlm.nih.gov/pubmedhealth/PMH0000732/

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