A Double-Blind Clinical Trial of Alprazolam,

Weissman, Myrna M.; PRUSOFF, BRIGITTE; Sholomskas, Alan J.; Greenwald, Steven

doi:10.1097/00004714-199206000-00005

Cited by 20 publications

(1 citation statement)

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“…First-line treatments in depression are tricyclic antidepressants (TCAs). Clinical studies in depressed patients showed that alprazolam is at least equally effective as TCAs, such as amitriptyline (13,66,76,126,157,249), imipramine (84,86,87,180,212,277), dosulepine (41), desipramine (85,210), or doxepin (9). However, other studies reported that, although alprazolam provided symptom relief, amitriptyline (124,159,227) and imipramine (103,161) were significantly more effective.…”

Section: Depressionmentioning

confidence: 99%

Clinical Pharmacology, Clinical Efficacy, and Behavioral Toxicity of Alprazolam: A Review of the Literature

2004

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Alprazolam is a benzodiazepine derivative that is currently used in the treatment of generalized anxiety, panic attacks with or without agoraphobia, and depression. Alprazolam has a fast onset of symptom relief (within the first week); it is unlikely to produce dependency or abuse. No tolerance to its therapeutic effect has been reported. At discontinuation of alprazolam treatment, withdrawal and rebound symptoms are common. Hence, alprazolam discontinuation must be tapered. An exhaustive review of the literature showed that alprazolam is significantly superior to placebo, and is at least equally effective in the relief of symptoms as tricyclic antidepressants (TCAs), such as imipramine. However, although alprazolam and imipramine are significantly more effective than placebo in the treatment of panic attacks, Selective Serotonin Reuptake Inhibitors (SSRIs) appear to be superior to either of the two drugs. Therefore, alprazolam is recommended as a second line treatment option, when SSRIs are not effective or well tolerated. In addition to its therapeutic effects, alprazolam produces adverse effects, such as drowsiness and sedation. Since alprazolam is widely used, many clinical studies investigated its cognitive and psychomotor effects. It is evident from these studies that alprazolam may impair performance in a variety of skills in healthy volunteers as well as in patients. Since the majority of alprazolam users are outpatients, this behavioral impairment limits the safe use of alprazolam in patients routinely engaged in potentially dangerous daily activities, such as driving a car.

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Section: Depressionmentioning

confidence: 99%

Clinical Pharmacology, Clinical Efficacy, and Behavioral Toxicity of Alprazolam: A Review of the Literature

2004

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Antidepressants versus placebo for the depressed elderly

Wilson

Mottram

Sivananthan

et al. 2001

Cochrane Database of Systematic Reviews

152

103

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Background Depression warranting intervention is found in ten percent of people over the age of 60. Older depressed people are more likely to die than non-depressed. Relatively few receive therapeutic interventions, and those that do, tend to receive low dose antidepressant therapy. Depression in older people is thought to di er in terms of aetiology, presentation, treatment and outcome than in younger people. Concomitant physical illness and increasing social, physical and neurophysiological diversity are associated with the ageing process. Consequently drug treatment of older patients is o en carried out in institutions and on patients su ering from multiple physical problems. Objectives To determine the e icacy of antidepressant medication compared with placebo in the treatment of depression in older patients. Search methods The search strategy incorporated: electronic literature searches of databases held by the Cochrane Collaboration Depression, Anxiety and Neurosis Review Group (CCDAN) (see Collaborative Review Group Search Strategy). Reference lists of related reviews and references of located studies. Contact was made with authors working in the field. Selection criteria All randomised, placebo controlled trials using antidepressants in the treatment of the presenting episode of depression in patients described as elderly, geriatric senile or older adult. Data collection and analysis Two types of data were extracted (if available) from each study. The first type of data was dichotomous data, this consisted of recovered/not recovered. The second, continuous data,included: Hamilton Depression Rating Scale (HAM-D), Montgomery-Asberg Rating Scale (MADRS) and other depression rating scale scores. An analysis using Peto Odds ratios for the dichotomous data and weighted mean di erence for continuous data was performed using RevMan 3.1. The presence of heterogeneity of treatment e ect was assessed. Main results Seventeen trials contributed data to the analyses comparing the e icacy of antidepressant treatment and placebo. Analyses of e icacy were based on 245 patients treated with Tricyclic antidepressants (223 with placebo), 365 patients treated with SSRIs (372 with placebo) and 58 patients treated with MAOIs (63 with placebo). The results using a fixed e ect model, for the three groups respectively were,

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