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The efficacy of paroxetine and fluoxetine and their effects on cognitive and behavioural function were compared in a 6 week, double-blind, randomized study of 106 elderly depressed patients (aged 61 to 85 years). Antidepressant efficacy was assessed using the Hamilton depression rating scale (HAMD), Montgomery-Asberg Depression Rating Scale (MADRS) and Clinical Global Impression (CGI) scale. The Sandoz Clinical Assessment Geriatric scale (SCAG), the Mini-Mental State Examination (MMSE), and HAMD cognitive factor scores were used to assess cognitive and behavioural function. Paroxetine demonstrated comparable efficacy to fluoxetine in the treatment of elderly depressed patients, but at the end of treatment, there was a significantly higher proportion of responders to paroxetine than to fluoxetine. Both treatments produced improvements in all measures of cognitive and behavioural function, but paroxetine was significantly superior to fluoxetine from Week 3, indicating a possible early effect. There was no difference between the two agents in either the tolerability or safety of treatment.