Article Figures & Data
Figures
- Figure 1.
Number of studies from the initial search (12 from the initial search and 3 from the updated search)
- Figure 2.
Tricyclic vs placebo for improvement.
- Figure 3.
SSRI vs placebo for improvement.
- Figure 4.
Tricyclic vs placebo for adverse effects leading to withdrawal.
- Figure 5.
SSRI vs placebo for adverse effects leading to withdrawal.
Tables
- Table 1.
Features of 15 Randomized Trials Comparing Either a Selective Serotonin Reuptake Inhibitor (SSRI) or Tricyclic Antidepressant (TCA) With Placebo
Study Quality* Diagnosis TCA Dose† Responsible for Treatment Competing Interest Study Period Outcome 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, specified inclusion, details of withdrawals, valid outcomes. † High dose defined as majority of TCA treated patients receiving at least equivalent of 100 mg/d amitriptyline (60 mg mianserin). ‡ Study has 3 arms (SSRI vs TCA vs placebo). TCA vs placebo Blashki et al26 High Heterogeneous High and low GP and psychiatrist No 4 wk HAMD Brink et al27 Low Heterogeneous High GP Yes 6 wk HAMD Doogan & Langdon19‡ High MDD High GP Yes 6 wk MADRS 50%M Feighner et al24 High Heterogeneous High Psychiatrist No 4 wk HAMD 50%H Hollyman et al23 High Heterogeneous High Psychiatrist No 6 wk HAMD 50%H Lecrubier et al25 Low Heterogeneous High Psychiatrist Yes 12 wk HAMD 50%H Malt et al17‡ High Heterogeneous High GP Yes 24 wk MADRS 50%M Mynors-Wallis et al21 High Heterogeneous High GP No 12 wk MADRS Philipp et al20 Low ModDD Low GP Yes 8 wk HAMD Thompson & Thompson28 Low Heterogeneous Low GP No 4 wk HAMD Thomson et al22 Low Heterogeneous High GP Yes 12 wk HAMD Barge-Schaapveld & Nicholson29 Low MDD High Unclear Yes 6 wk HAMD SSRI vs placebo Doogan & Langdon19* High MDD 100 mg sertraline GP Yes 6 wk MADRS 50%M Lepola et al18 Low MDD 10 mg escitalopram Unclear Yes 8 wk MADRS 50%M Malt et al17† High Heterogeneous 100 mg sertraline GP Yes 24 wk MADRS Montgomery et al30 High MDD 10 mg escitalopram or 20 mg citalopram Unclear Yes 4 wk MADRS Wade et al16 High MDD 10 mg escitalopram Unclear Yes 8 wk MADRS
The Article in Brief
Efficacy and tolerability of tricyclic antidepressants and SSRIs compared with placebo in primary care treated depression. A Meta-analysis
By Bruce Arroll, MBChB, PhD, and colleagues
Background: Most patients with clinical depression are seen in a primary care setting. Yet most studies examining the effectiveness of antidepressant medications are done with patients who see a psychiatric specialist and whose depression may have a different cause and disease course. This study examined existing evidence about the effectiveness of antidepressants for treating depression, as compared to placebos, among primary care patients.
What this study found: Two types of antidepressants--tricyclic antidepressants, which work by increasing levels of the mood chemicals serotonin and norepinephrine in the brain, and selective serotonin reuptake inhibitors, which work by increasing the amount of serotonin�are significantly more effective than placebo in primary care settings. In addition, the relatively low doses of tricyclic antidepressants sometimes used in primary care may be effective.
Implications
� Prescribing antidepressants in primary care is more effective than prescribing a placebo.
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