A Canadian multicenter, double-blind study of paroxetine and fluoxetine in major depressive disorder

Chouinard, Guy; Saxena, B.; Bélanger, Marie‐Claire; Ravindran, Arun; Bakish, David; Beauclair, Linda; Morris, Paul; Nair, N.P.V.; Manchanda, Rahul; Reesal, Robin T.; Remick, Ronald A.; O'Neill, Megan

doi:10.1016/s0165-0327(98)00188-8

Cited by 51 publications

(22 citation statements)

References 17 publications

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“…However, examination of various studies [20,34,35] shows us that this type of withdrawal occurs with SSRIs as well as with other CNS drugs. Rosenbaum et al [20] demonstrated rebound major depression, although the authors did not describe it as such, in a double-blind withdrawal trial (5-8 days) conducted in 242 patients with major depression who had their maintenance paroxetine, sertraline or fluoxetine treatment interrupted [20].…”

Section: Rebound Symptomsmentioning

confidence: 99%

“…Importantly, if the patient is not already taking fluoxetine, it should be started during the tapering of the SSRIs to aid in withdrawing from it. Given the evidence for the high risk of disabling withdrawal with paroxetine, thought to be related to noradrenergic and cholinergic supersensitivity [15,35], its shorter half-life (19 h compared with 45 h for fluoxetine), and earlier steady-state concentration (7-14 days for paroxetine compared with 28-35 days with fluoxetine) [35], we recommend that paroxetine should not be given before exploring other treatment alternatives.…”

Section: Clinical Strategies For the Management Of Ssri Withdrawalmentioning

confidence: 99%

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New Classification of Selective Serotonin Reuptake Inhibitor Withdrawal

Chouinard

2015

Psychother Psychosom

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141

268

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Section: Rebound Symptomsmentioning

confidence: 99%

Section: Clinical Strategies For the Management Of Ssri Withdrawalmentioning

confidence: 99%

New Classification of Selective Serotonin Reuptake Inhibitor Withdrawal

Chouinard

2015

Psychother Psychosom

Self Cite

141

268

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“…Rates of treatment-emergent sexual dysfunction in depressed patients from randomized clinical trials range from 15 to 80 percent [10,11]. Using data from a cross-sectional study in Europe, study authors estimated the prevalence of treatment-emergent sexual dysfunction in depressed patients prescribed either a selective serotonin reuptake inhibitor or serotonin-noradrenaline reuptake inhibitors to be between 37.1 percent and 61.5 percent [12].…”

Section: Introductionmentioning

confidence: 99%

“…A few systematic reviews addressed the issue of sexual dysfunction associated with SGAD in patients with MDD [10,[15][16][17][18][19]. With the exception of an updated meta-analysis by Gartlehner et al [11], which also included data from observational studies, previous systematic reviews focused on efficacy trials.…”

Section: Introductionmentioning

confidence: 99%

Sexual Dysfunction associated with Second-Generation Antidepressants in Patients with Major Depressive Disorder: Results from a Systematic Review with Network Meta-Analysis

et al. 2013

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BACKGROUND: Sexual dysfunction (SD) is prevalent in patients with major depressive disorder (MDD) and is also associated with second-generation antidepressants (SGAD) which are commonly used to treat the condition. Evidence indicates underreporting of SD in efficacy studies. SD associated with antidepressant treatment is a serious side effect that may lead to early termination of treatment and worsening of quality of life. OBJECTIVES: To systematically assess the harms of SD associated with SGAD in adult patients with MDD by drug type. METHODS: We retrieved English-language abstracts from PubMed, EMBASE, the Cochrane Library, PsycINFO, and International Pharmaceutical Abstracts from 1980 to October 2012 as well as from reference lists of pertinent review articles and grey literature searches. Two independent reviewers identified randomized controlled trials (RCTs) of at least six weeks' duration and observational studies with at least 1,000 participants. STUDY SELECTION: Reviewers abstracted data on study design, conduct, participants, interventions, outcomes and method of SD ascertainment, and rated risk of bias. A senior reviewer checked and confirmed extracted data and risk of bias ratings. ANALYSES: Random effects network meta-analysis using Bayesian methods for data from head-to-head trials and placebo-controlled comparisons; descriptive analyses calculating weighted mean rates from individual trials and observational studies. RESULTS/ SYNTHESIS: Data from sixty-three studies of low and moderate risk of bias (58 RCTs, five observational studies) with more than 26,000 patients treated with SGAD were included. Based on network meta-analyses of 66 pairwise comparisons from 37 RCTs, most comparisons showed a similar risk of sexual dysfunction among included SGAD. Credible intervals, however, were wide and included differences that would be considered clinically relevant. We observed three main patterns: Bupropion had a statistically significantly lower risk of sexual dysfunction than some other SGAD, and both escitalopram, and paroxetine showed a statistically significantly higher risk of sexual dysfunction than some other SGAD. We found reporting of harms related to sexual dysfunction inconsistent and insufficient in some trials. LIMITATIONS: Most trials were conducted in highly selected populations. Search was restricted to English-language only. CONCLUSION AND IMPLICATIONS: Because of the indirect nature of the comparisons, the often wide credible intervals, and the high variation in magnitude of 2 outcome, we rated the overall strength of evidence with respect to our findings low. The current degree of evidence does not allow a precise estimate of comparative risk of sexual dysfunction associated with a specific antidepressant. In the absence of such evidence, clinicians need to be aware of SD as a common adverse event and should discuss patients' preferences before initiating antidepressant therapy.

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“…There was no complaint of headache or insomnia in 12 subjects, although these are common side effects among patients treated with selective serotonin reuptake inhibitors (SSRIs). 13 Clomipramine caused hyperhydrosis in a 64-year-old man with semantic dementia when given for anxiety and obsessive-compulsive toileting behaviors. The same subject could not tolerate any SSRI drugs.…”

Section: Resultsmentioning

confidence: 99%

Goals in symptomatic pharmacologic management of frontotemporal lobar degeneration

Chow

Mendez

2002

Am J Alzheimers Dis Other Demen

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This review of pharmacotherapy for frontotemporal lobar degeneration describes the chemical rationale for agents used and reports observed responses to psychotropic medications. Paroxetine addressed anxiety and repetitive, ritualistic behaviors. Depression was resistant to treatment. Valproic acid and quetiapine calmed agitated subjects without exacerbating Parkinsonism. Donepezil has not emerged as a beneficial medication for this group of subjects. Behavioral disturbances can be alleviated pharmacologically, but further research might determine guidelines for management of this non-Alzheimer's dementia syndrome that could decrease the frequency of adverse drug events.

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A Canadian multicenter, double-blind study of paroxetine and fluoxetine in major depressive disorder

Cited by 51 publications

References 17 publications

New Classification of Selective Serotonin Reuptake Inhibitor Withdrawal

New Classification of Selective Serotonin Reuptake Inhibitor Withdrawal

Sexual Dysfunction associated with Second-Generation Antidepressants in Patients with Major Depressive Disorder: Results from a Systematic Review with Network Meta-Analysis

Goals in symptomatic pharmacologic management of frontotemporal lobar degeneration

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