A randomised, double-blind comparison of the efficacy and safety of citalopram compared to mianserin in elderly, depressed patients with or without mild to moderate dementia

Karlsson, Ingvar; Godderis, Jan; Lima, Cabral; Nygaard, Harald A.; Simányi, Margarete; Taal, Maarja; Eglin, Mirjam

doi:10.1002/(sici)1099-1166(200004)15:4<295::aid-gps105>3.0.co;2-c

Cited by 61 publications

(17 citation statements)

References 42 publications

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“…Of the 13 potentially relevant RCTs retrieved in the literature searches, 8 were excluded for the following reasons: medication not available in North America 35 ; study population did not have depression 36 ; only a portion of the study population had dementia and were not explicitly identified in the study 38,39 ; or study data were only presented as P values. 40 Raw study data were requested from several studies' authors and sites and (or) drug manufacturers [38][39][40] ; however, this information was not received.…”

Section: Resultsmentioning

confidence: 99%

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Efficacy and Safety of Antidepressants for Treatment of Depression in Alzheimer's Disease: A Metaanalysis

Thompson¹,

et al. 2007

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Objective: Depression in patients with Alzheimer's disease (AD) is common (15% to 63%) and is associated with significant morbidity and increased mortality. Our objective was to quantitatively summarize the data on the efficacy and safety of antidepressant treatment for depression complicating AD. Method:We performed a metaanalysis of randomized, double-blind, placebo-controlled trials of antidepressants with a database search of the English literature (up to 2006) and a manual search of references in the retrieved articles. We extracted the proportion of subjects who responded and remitted, experienced adverse events (AEs), discontinued treatment due to AEs, or discontinued treatment for any reason. Cognition scores were also extracted. Results:We included 5 studies, which involved 82 subjects treated with antidepressants and 83 subjects who received placebo treatment. Antidepressants were superior to placebo for both treatment response (odds ratio [OR] 2.32; 95% confidence interval [CI], 1.04 to 5.16) and remission of depression (OR 2.75; 95%CI, 1.13 to 6.65). There were no significant differences between the 2 groups for change in cognition (weighted mean difference -0.71, 95%CI, -3.20 to 1.79), overall dropouts (OR 0.70; 95%CI, 0.29 to 1.66) or dropout due to AEs (OR 1.41; 95%CI 0.36 to 5.54). The numbers needed to treat for one additional AD patient to respond to antidepressant treatment were 5 (95%CI, 3 to 59) and 5 (95%CI, 2 to 24) for remission of depression. Conclusions:Antidepressant treatment for depression in AD is efficacious, with rates of discontinuation that are comparable to placebo. Nonetheless, clinicians must be vigilant regarding the potential side effects of antidepressants in this population. Clinical Implications· Antidepressants are efficacious in the treatment of depression in AD. · Tolerability of antidepressants in AD appears to be similar to placebo. · TCAs may be associated with a decline in cognition. Limitations· Antidepressant classes were not compared because of the limited number of published trials in AD. · Individual AEs could not be analyzed. · Individual trials were limited by small sample sizes, low medication dosages, differing outcomes of interest, and varying outcomes measures.

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Section: Resultsmentioning

confidence: 99%

“…40 Raw study data were requested from several studies' authors and sites and (or) drug manufacturers [38][39][40] ; however, this information was not received. Two studies were not included 41,42 because they were head-to-head studies that…”

Section: Resultsmentioning

confidence: 99%

Efficacy and Safety of Antidepressants for Treatment of Depression in Alzheimer's Disease: A Metaanalysis

Thompson¹,

et al. 2007

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“…Depression was evaluated using the Montgomery‐Asberg Depression Rating Scale (MADRS), a validated, reliable tool for detecting depression in a AD population 31 . This scale has been shown to be sensitive to change in demented patients 32 . Patients with a score of 18 or higher were considered to be depressed.…”

Section: Methodsmentioning

confidence: 99%

Exercise Program for Nursing Home Residents with Alzheimer's Disease: A 1‐Year Randomized, Controlled Trial

Rolland

Pillard

Klapouszczak

et al. 2007

J American Geriatrics Society

570

578

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“…They are prescribed more often for elderly patients than any other psychotropic (Lasser and Sunderland, 1998), and are the antidepressant of choice for many practitioners (Rothera et al, 2002). Placebocontrolled studies are not available for citalopram and escitalopram, although comparison studies in the elderly are available, including a study of citalopram in an elderly depressed population with and without dementia (Karlsson et al, 2000). A placebo-controlled trial of citalopram in the elderly was conducted, but has not yet been published.…”

Section: Selective Serotonin Reuptake Inhibitorsmentioning

confidence: 99%

A Systematic Review of Antidepressant Placebo-Controlled Trials for Geriatric Depression: Limitations of Current Data and Directions for the Future

Taylor

Doraiswamy

2004

Neuropsychopharmacol

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Depression in the elderly is a major public health problem as untreated depression adversely impacts comorbid illnesses. It is important to develop safe and effective antidepressant therapies for older individuals. We performed a systematic review of all published randomized, placebo-controlled antidepressant medication trials in populations over age 55 years. Papers were obtained via MEDLINE (1966( -August 2003 and PSYCINFO (1872-August 2003. Unpublished trials, trials examining nonpharmacologic interventions, and papers reporting post hoc analyses were not included in this review unless they provided new insights. A total of 18 placebo-controlled trials examining acute efficacy met our criteria. The combined sample size in these studies was 2252. The mean sample size was 51 (range 20-728) and mean trial duration was 7 weeks. A total of 12 trials examined tricyclic antidepressants (TCAs), five trials examined selective serotonin reuptake inhibitors (SSRIs), two trials examined bupropion, and one trial examined mirtazapine. There were no published trials of venlafaxine or nefazodone. In all, 71.5% of trials reported significantly greater efficacy with drug than placebo. In conclusions, there is a paucity of published controlled antidepressant trials in the elderly. Most published studies examine small sample sizes and do not include common comorbid conditions. Efficacy studies examining relapse prevention are lacking. Large placebo response rates, lack of controlled head to head comparisons, and other methodological design differences make crosstrial comparisons difficult. Large simple studies are urgently needed to address the unmet needs for data on safety and efficacy of antidepressants in this population.

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A randomised, double-blind comparison of the efficacy and safety of citalopram compared to mianserin in elderly, depressed patients with or without mild to moderate dementia

Cited by 61 publications

References 42 publications

Efficacy and Safety of Antidepressants for Treatment of Depression in Alzheimer's Disease: A Metaanalysis

Efficacy and Safety of Antidepressants for Treatment of Depression in Alzheimer's Disease: A Metaanalysis

Exercise Program for Nursing Home Residents with Alzheimer's Disease: A 1‐Year Randomized, Controlled Trial

A Systematic Review of Antidepressant Placebo-Controlled Trials for Geriatric Depression: Limitations of Current Data and Directions for the Future

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