A double-blind, placebo-controlled comparison of sertraline and dothiepin in the treatment of major depression in general practice

Doogan, D P; Langdon, C J

doi:10.1097/00004850-199400920-00005

Cited by 55 publications

(26 citation statements)

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“…There were 890 participants in SSRI studies, 596 in TCA studies, and 1,267 patients on placebo (Table 1). [16][17][18][19][20][21][22][23][24][25][26][27][28][29][30] Of the 5 possible SSRIs available, 2 studied sertraline, 3 studied escitalopram (a precursor of citalopram), and 1 studied citalopram. Of the TCAs available, 2 studied dothiepin, 4 studied amitriptyline, 2 studied mianserin, and 3 studied imipramine.…”

Section: Resultsmentioning

confidence: 99%

“…16,18,19,30 Only 3 of the 4 studies had data suitable for pooling, and the relative risk was 1.39 (95% CI, 1.21 to 1.61).…”

Section: Tcas and Ssris Vs Placebo For Depressionmentioning

confidence: 99%

“…We also performed a funnel plot analysis to check for publication bias. There were a number of defi nitions for outcomes we described as "improvement": 4 defi nitions used ≤50% reduction in the Montgomery-Asberg Depression Rating Scale (MADRS), [16][17][18][19] ≤50% reduction in Hamilton Depression Rating Scale (HAMD), 20 ≤7 on the HAMD scale, 21 and ≤4 points on HAMD 22 ; and 3 defi nitions used global evaluation of improvement. …”

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confidence: 99%

“…Only 2 TCA studies had major depressive disorder as the single diagnosis, and the weighted mean difference for that study was -1.37 (95% CI, -2.52 to -0.22). 19,29 For the SSRI studies there were 4 studies HAMD = Hamilton depression scale; 50%H = discrete outcomes where improvement is a greater than 50% reduction in HAMD; MADRS= Montgomery-Asberg Depression Rating Scale; 50%M = discrete outcomes where improvement is a greater than 50% reduction in the MADRS; heterogeneous = patients thought by their general practitioner to be depressed, which may or may not include patients with major depression as opposed to the studies with only patients with major depression; MDD = major depressive disorder; ModDD = moderate depressive disorder.* Quality high if adequate sample size, concealment, description of treatment, representative sample, specifi ed inclusion, details of withdrawals, valid outcomes. † High dose defi ned as majority of TCA treated patients receiving at least equivalent of 100 mg/d amitriptyline (60 mg mianserin).…”

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confidence: 99%

“…19,29 Three studies of SSRIs included only patients with major depressive disorder. 16,18,19 As patients in primary care settings have a range of depression severity, the generalizability of the results of these studies to primary care is reasonable. 40 Advice on using TCAs has stressed that patients will not obtain a benefi t from medication until 2 weeks of treatment has passed.…”

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confidence: 99%

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Efficacy and Tolerability of Tricyclic Antidepressants and SSRIs Compared With Placebo for Treatment of Depression in Primary Care: A Meta-Analysis

Arroll

MacGillivray²,

Ogston³

et al. 2005

The Annals of Family Medicine

300

166

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PURPOSE Depression is common in primary care. There are no systematic reviews of depression treatment comparing antidepressants with placebo; hence, we do not know whether these medications are effective in primary care. METHODSWe searched the Cochrane Collaboration Depression, Anxiety and Neurosis Group register of controlled trials, MEDLINE, International Pharmaceutical abstracts, PsycINFO, and EMBASE. Abstracts of potential studies were reviewed independently by 2 authors. Studies needed to include randomized controlled trials of either a tricyclic antidepressant (TCA) or selective serotonin reuptake inhibitor (SSRI), or both, and placebo in a primary care setting. The data and quality of the studies were extracted and assessed by 2 authors blind to the other's choice. Disagreements were resolved by discussion. The main outcome measures were the standardized mean difference and weighted mean difference of the fi nal mean depression scores, the relative risk of improvement, and the number withdrawing because of side effects. Pooling of results was done using Review Manager 4.2.2.RESULTS There were 10 studies in which TCAs were compared with placebo, 3 in which SSRIs were compared with placebo, and 2 with both compared with placebo. One half of the studies were of low methodological quality, and nearly all studies were of short duration, typically 6 to 8 weeks. Pooled estimates of effi cacy data showed a relative risk of 1.26 (95% CI, 1.12-1.42) for improvement with TCAs compared with placebo; For SSRIs, relative risk was 1.37 (95% CI, 1.21-1.55). Most patients, 56% to 60%, responded well to active treatment compared with 42% to 47% for placebo. The number needed to treat for TCAs was about 4, and for SSRIs it was 6. The numbers needed to harm (for withdrawal caused by side effects) ranged from 5 to 11 for TCAs and 21 to 94 for SSRIs. Low-dose (100 mg or 75 mg) as well as high-dose TCAs were effective.CONCLUSION This systematic review is the fi rst comparing antidepressants with placebo for treatment of depression in primary care. Both TCAs and SSRIs are effective. This review is also the fi rst to show that low-dose TCAs are effective in primary care. Prescribing antidepressants in primary care is a more effective clinical activity than prescribing placebo. Doubts about the effectiveness of antidepressant medication and other therapies, such as cognitive therapy, may contribute to the variability in primary care management of depression.3,4 Up to 40% of depressed patients fail to show a response to fi rst-line antidepressant drug treatment, 5 and of those that do respond, only a proportion will achieve full recovery.6 One cohort study of primary care patients found that 60% of depressed patients treated with medication and 50% with milder depression still met the criteria for caseness at 1 year. 7Recent reports have indicated an urgent need to review the evidence of only those studies of antidepressant effi cacy on patient samples based in primary care. 8,9 Several completed reviews and protocols are c...

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Section: Resultsmentioning

confidence: 99%

“…16,18,19,30 Only 3 of the 4 studies had data suitable for pooling, and the relative risk was 1.39 (95% CI, 1.21 to 1.61).…”

Section: Tcas and Ssris Vs Placebo For Depressionmentioning

confidence: 99%

mentioning

confidence: 99%

mentioning

confidence: 99%

mentioning

confidence: 99%

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Efficacy and Tolerability of Tricyclic Antidepressants and SSRIs Compared With Placebo for Treatment of Depression in Primary Care: A Meta-Analysis

Arroll

MacGillivray²,

Ogston³

et al. 2005

The Annals of Family Medicine

300

166

View full text Add to dashboard Cite

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A Double-Blind Comparison of Sertraline and Imipramine in Outpatients with Major Depression: Acute (8 Weeks) and Continuation (16 Weeks) Treatment

Fournier¹,

Lane

Chouinard³

et al. 1997

Hum. Psychopharmacol. Clin. Exp.

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In a double-blind multicentre trial in patients with major depression, the ecacy and the tolerability of sertraline were compared to those of imipramine, during an 8-week acute treatment phase followed by a 16-week continuation treatment phase in treatment responders. A total of 104 patients who met DSM-III-R criteria for major depression, HAM-D 17-item518 and Raskin Depression score > Covi Anxiety score, were randomized to receive either sertraline or imipramine. The initial daily dosage of 50 mg of sertraline or imipramine was rapidly titrated upwards in increments of 50 mg/day at weekly intervals, tolerability permitting, to a maximum of 200 mg/day by the fourth week. Eighty-eight patients completed at least 3 weeks of treatment and were included in the ecacy evaluable population. Both treatment groups demonstrated similar improvements on depression and anxiety rating scales during acute treatment, however, sertraline demonstrated signi®cantly more improvement relative to imipramine on the HAM-D and Covi Anxiety scales after 1 week of treatment. Sertraline was more eective (HAM-D 17-item, CGI-S, SCL-56 Total score, SCL-56 Depression score, Covi Anxiety score) than imipramine in reducing depressive symptoms at the end of 24 weeks of treatment. There were signi®cant improvements in all rating scales at week 24 relative to week 8 in the sertraline group but not in the imipramine group. The SCL-56 Total score, SCL-56 Depression score, Raskin Depression score and Covi Anxiety score at week 24 relative to week 8 showed signi®cantly greater improvement in the sertraline group compared to the imipramine group. Imipramine was associated with a signi®cantly higher incidence of dry mouth, sweating, constipation, palpitations, and a signi®cantly higher heart rate and blood pressure. Sertraline was associated with a signi®cantly higher incidence of diarrhoea/loose stools and insomnia. This study demonstrated a faster onset of therapeutic eect for sertraline relative to imipramine, re¯ecting the initiation of sertraline in a therapeutic dose of 50 mg/day and the need for gradual titration of imipramine to a therapeutic dose, at the beginning of treatment. Although ecacy was similar in both treatment groups at the end of the 8 weeks of acute therapy, sertraline-treated patients continued to manifest gradual improvements in depressive and anxiety symptoms during the 16 weeks of continuation therapy such that sertraline-treated patients were signi®cantly more improved at the end of 24 weeks of therapy.

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Treatment of severe depression with the selective serotonin reuptake inhibitors

Schatzberg

1996

Depress. Anxiety

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The selective serotonin reuptake inhibitors (SSRIs) are recognized as effective as and better tolerated than older antidepressant therapies and have become the drugs of choice in the treatment of mild to moderate depression. However, there is a clinical impression that the SSRIs are less effective than older therapies in the severely depressed patient. A limited number of trials have attempted to address this issue. This review assesses 16 controlled studies of SSRIs in severe depression. The findings from a majority of studies found the SSRIs to be superior to placebo and as effective as but better tolerated than the tricyclic antidepressants (TCAs) in severely depressed patients. Although future studies are needed to corroborate and elaborate on these data, studies still support the use of SSRIs in this patient population. Depression and Anxiety 4:182–189, 1996/1997. © 1997 Wiley‐Liss, Inc.

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A double-blind, placebo-controlled comparison of sertraline and dothiepin in the treatment of major depression in general practice

Cited by 55 publications

References 0 publications

Efficacy and Tolerability of Tricyclic Antidepressants and SSRIs Compared With Placebo for Treatment of Depression in Primary Care: A Meta-Analysis

Efficacy and Tolerability of Tricyclic Antidepressants and SSRIs Compared With Placebo for Treatment of Depression in Primary Care: A Meta-Analysis

A Double-Blind Comparison of Sertraline and Imipramine in Outpatients with Major Depression: Acute (8 Weeks) and Continuation (16 Weeks) Treatment

Treatment of severe depression with the selective serotonin reuptake inhibitors

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