Efficacy of bupropion and the selective serotonin reuptake inhibitors in the treatment of anxiety symptoms in major depressive disorder: A meta-analysis of individual patient data from 10 double-blind, randomized clinical trials

Papakostas, George I.; Trivedi, Madhukar H.; Alpert, Jonathan E.; Seifert, Cheryl A.; Krishen, Alok; Goodale, Elizabeth P.; Tucker, Vivian L.

doi:10.1016/j.jpsychires.2007.05.012

Cited by 38 publications

(24 citation statements)

References 38 publications

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“…There is a small advantage (6%) of SSRIs as compared to bupropion in the treatment of anxious depression. 35,36 Negative affectivity, which captures high levels of stress, irritability, and anxiety, may be similar to DSM-5 major depression with anxious distress. This subgroup may be better treated with a medication like escitalopram that enhances serotonergic neurotransmission as compared to bupropion, which enhances dopaminergic neurotransmission.…”

Section: Discussionmentioning

confidence: 99%

Treatment of Maternal Depression in a Medication Clinical Trial and Its Effect on Children

Weissman¹,

Wickramaratne²,

Pilowsky³

et al. 2015

AJP

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Objective Observational studies show that when a depressed mother’s symptoms remit, her children’s symptoms decrease. Without random assignment of mother’s treatment, we cannot conclude that the child’s improvement is due to the mother’s treatment. The objective is to determine the differential effects of a depressed mother’s treatment on her child. Methods Randomized double-blind 12-week clinical trial of escitalopram, bupropion, or the combination in depressed mothers (N=76), and independent assessment of their children (N=135) ages 7–17 years. We hypothesized that mothers on combination treatment would have significantly earlier onset and higher rate of remission than on either monotherapy. The mothers’ outcome would be reflected in their children. Results There were no significant treatment differences in mothers’ depressive symptoms or remission. However, children’s depressive symptoms and functioning improved significantly if their mothers received escitalopram (vs. bupropion and combination). Only in the escitalopram group was significant improvement of mother’s depression associated with improvement in the child’s symptoms. Exploratory analyses suggested that this may be due to changes in parental functioning: Mothers on escitalopram (vs. bupropion and combination) reported significantly greater improvement in their ability to listen and talk to their children, who as a group reported that their mothers were more caring over the 12 weeks. Mother’s baseline negative affectivity appeared to moderate the effect of mother’s treatment on children, although the effect was not statistically significant. Children of mothers with low negative affectivity improved on all treatments. Children of mothers with high negative affectivity improved significantly only if the mother was on escitalopram (vs. bupropion and combination). Conclusions The effects of the depressed mother’s improvement on her children may depend on her type of treatment. Depressed mothers with high anxious distress and irritability may require medications that reduce these symptoms in order to show the effect of her remission on her children.

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Section: Discussionmentioning

confidence: 99%

Treatment of Maternal Depression in a Medication Clinical Trial and Its Effect on Children

Weissman¹,

Wickramaratne²,

Pilowsky³

et al. 2015

AJP

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“…Midbrain NE has been associated with the regulation of anxiety (Simon et al, 2009, Watt et al, 2009) and motivation (Heimovics et al). Moreover, increasing NE and 5-HT levels by inhibition of NE-DA uptake is a common intervention used to treat anxiety in depressive disorders (Tollefson et al, 1991, Papakostas et al, 2008). Uptake of NE-DA in prefrontal cortex is mediated by NET, and it was recently demonstrated (Siuta et al) that animals with impaired mTORC2 function show increased prefrontal NET, resulting in increased levels of prefrontal NE concomitant with decreased DA.…”

Section: 4 Discussion and Conclusionmentioning

confidence: 99%

Chronic inhibition of mammalian target of rapamycin by rapamycin modulates cognitive and non-cognitive components of behavior throughout lifespan in mice

et al. 2012

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Aging is, by far, the greatest risk factor for most neurodegenerative diseases. In non-diseased conditions, normal aging can also be associated with declines in cognitive function that significantly affect quality of life in the elderly. It was recently shown that inhibition of mTOR activity in mice by chronic rapamycin treatment extends lifespan, possibly by delaying aging {Harrison, 2009 #4}{Miller, 2011 #168}. To explore the effect of chronic rapamycin treatment on normal brain aging we determined cognitive and non-cognitive components of behavior throughout lifespan in male and female C57BL/6 mice that were fed control- or rapamycin-supplemented chow. Our studies show that rapamycin enhances cognitive function in young adult mice and blocks age-associated cognitive decline in older animals. In addition, mice fed with rapamycin-supplemented chow showed decreased anxiety and depressive-like behavior at all ages tested. Levels of three major monoamines (norepinephrine, dopamine and 5-hydroxytryptamine) and their metabolites (3,4-dihydroxyphenylacetic acid, homovanillic acid, and 5-hydroxyindolacetic acid) were significantly augmented in midbrain of rapamycin-treated mice compared to controls. Our results suggest that chronic, partial inhibition of mTOR by oral rapamycin enhances learning and memory in young adults, maintains memory in old C57BL/6J mice, and has concomitant anxiolytic and antidepressant-like effects, possibly by stimulating major monoamine pathways in brain.

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“…In a large‐scale meta‐analysis of 102 randomized clinical trials (with more than 10,000 depressed patients), SSRI medications had a slightly greater advantage with regards to tolerability and lower side effects compared to tricyclic medications . To complement this, results from a meta‐analysis of 10 double‐blind randomized clinical studies indicate no difference between antidepressant medications at the acute phase outcome point, with regards to the trajectory of response during treatment or with emergent anxiety. More specific comparisons, for example, comparing an SSRI (i.e., sertraline) with non‐SSRI medication (i.e., buproprion hydrochloride sustained release, an aminoketone that serves a noradrenergic and/or dopaminergic function), data indicate no differences in baseline anxiety, number of weeks in which anxiety emerged or attenuated during treatment, and the mean change of anxiety symptoms during the acute phase , …”

Section: Introductionmentioning

confidence: 99%

What are the clinical implications of new onset or worsening anxiety during the first two weeks of SSRI treatment for depression?

et al. 2011

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Objective To evaluate the prevalence of new onset or worsening of anxiety symptoms, as well as their clinical implications, during the first two weeks of Selective Serotonin Reuptake Inhibitor (SSRI) pharmacotherapy for depression. Method Adult outpatients with non-psychotic major depressive disorder were enrolled in an 8-week acute phase SSRI treatment trial at 15 clinical sites across the US. Worsening anxiety was defined as a greater than 2 point increase on the Beck Anxiety Inventory (BAI) between baseline and Week 2. New onset of anxiety symptoms was ascribed when the BAI baseline rating was 0 and the Week 2 value was greater or equal to 2 points on the BAI. Results Overall, after two weeks of treatment, 48.8% (98 of 201 participants) reported improvement in anxiety symptoms, 36.3% (73 of 201) reported minimal symptom change, and 14.9% (30 of 201) reported worsening of anxiety symptoms. No association was found between change in anxiety symptoms within the first two weeks and change in depressive symptoms or remission at the end of 8 weeks of treatment. For participants with clinically meaningful anxiety symptoms at baseline, however, worsening of anxiety during the first two weeks of treatment was associated with worsening depressive symptoms by 8 weeks (p = .054). Conclusions The trajectory of anxiety symptom change early in SSRI treatment is an important indicator of eventual outcome for outpatients with major depression and baseline anxiety symptoms.

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Efficacy of bupropion and the selective serotonin reuptake inhibitors in the treatment of anxiety symptoms in major depressive disorder: A meta-analysis of individual patient data from 10 double-blind, randomized clinical trials

Cited by 38 publications

References 38 publications

Treatment of Maternal Depression in a Medication Clinical Trial and Its Effect on Children

Treatment of Maternal Depression in a Medication Clinical Trial and Its Effect on Children

Chronic inhibition of mammalian target of rapamycin by rapamycin modulates cognitive and non-cognitive components of behavior throughout lifespan in mice

What are the clinical implications of new onset or worsening anxiety during the first two weeks of SSRI treatment for depression?

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