1,721,453 research outputs found
Amitriptyline versus other tricyclic drugs and selectivev serotonine reuptake inhibitors (SSRIs) for depression [Protocoll]
No full textAmitriptyline versus the rest: still the leading antidepressant after 40 years of randomised controlled trials
No full textBackground Tricyclic antidepressants have similar efficacy and slightly lower tolerability than selective serotonin reuptake inhibitors (SSRls). However, there are no systematic reviews assessing amitriptyline, the reference tricyclic drug, v. other tricyclics and SSRls directly. Aims To review the tolerability and efficacy of amitriptyline in the management of depression. Method Asystematic review of randomised controlled trials (RCTs) comparing amitriptyline with other tricyclics/heterocyclics or with an SSRl. Results We reviewed 186 RCTs. The overall estimate of the efficacy of amitriptyline revealed a standardised mean difference of 0.147 (95% CI 0.05-0.243), significantly favouring amitriptyline. The overall OR for dropping out was 0.99 (95% CI 0.91-1.08) and that For side-effects was 0.62 (95% Cl 0.54-0.70), Favouring the control drugs. With drop-outs included as treatment failures, the estimate of the effectiveness of amitriptyline v. tricyclics/heterocyclics and SSRls showed a 2.5% difference in the proportion of responders in favour of amitriptyline (number needed to treat 40, Cl 21-694; OR 1.12 (95% Cl 1.01-1.24)). Conclusions Amitriptyline is less well tolerated than tricyclics/hetrocyclics and SSRls, but slightly more patients treated on it recover than on alternative antidepressants
"Wish bias" in antidepressant drug trials?
No full textThe present study investigated whether the outcome of randomized clinical trials studying fluoxetine favored fluoxetine, where this was the experimental agent, and favored comparator antidepressants in trials where fluoxetine was the reference agent. A systematic review of all double-blind, randomized clinical trials comparing fluoxetine with any other antidepressant drug in patients suffering from depression was carried out. Thirty-seven studies meeting the inclusion criteria were analyzed. A metaregression analysis indicated that, after adjusting for possible confounders, studies where fluoxetine was the experimental agent were positively associated with treatment effect, indicating a significant advantage for fluoxetine. The evidence that the outcome of fluoxetine trials varied according to whether this drug was used as a new compound or a reference one suggests the presence of bias
Forty years of antidepressant drug trials
No full textObjective: This study was conducted to investigate whether the quality of antidepressant drug trials has improved during the last 40 years. Method: A sample of 314 randomized clinical trials published between 1962 and 1998 was analysed. Results: From 1962 to 1970 the median number of patients per trial was 56 (range 24-137), from 1971 to 1980 was 50 (10-211) and from 1981 to 1990 was 51 (20-314). In the last 8 years the median sample size increased to 100 patients (20-1002). Trials had a median duration of 4 weeks in the first two decades of publication, and a median duration of 6 weeks in the following two decades. Patient selection criteria have become increasingly sophisticated and the median number of efficacy measures increased in the last 4 decades from 1 to 4. Conclusion: Stringent selection criteria and sophisticated outcome assessment tend to exclude typical patients from randomized controlled trials and made it more difficult to follow many patients in the long term
Depression in palliative care: a systematic review. Part 2. Treatment
No full textObjective: To summarize available literature containing data on the treatment of depression in palliative care patients.Methods: A systematic review was conducted using extensive electronic databases and hand searches. All randomized controlled trials (RCTs) of interventions for depression in patients with advanced disease were eligible.Results: Three RCTs assessed pharmacological treatments. Of these, two were placebo controlled and assessed mianserin and thioridazine. The third compared two antidepressants. There were no RCTs that specifically assessed psychotherapy for patients with depression.Conclusion: There are too few adequate studies to draw clear conclusions about management of depression in this setting. The treatment of depression in patients with advanced disease must, for now, be informed by the larger body of evidence on effective treatments for depression in patients with either no physical illness or less severe medical conditions
Economic evaluation of antidepressive agents: a systematic critique of experimental and observational studies
No full textThe purpose of this study was to examine whether experimental and observational pharmacoeconomic analyses of antidepressant drugs support the choice of one of the selective serotonin reuptake inhibitors or newer antidepressants as first-line treatment for patients with major depression. We systematically reviewed economic evaluations of two or more antidepressants completed in clinical practice. A systematic electronic search yielded 38 studies meeting the inclusion criteria, of which 23 were administrative database analyses, 12 were observational studies, and 3 were randomized clinical trials. Experimental data indicated that tricyclic antidepressants are equivalent to selective serotonin reuptake inhibitors in terms of total expenditure. While the database analyses are susceptible to bias and confounding variables, they provided an added dimension based on observations from everyday clinical practice. The majority of these studies failed to show any significant difference. Taken together, available pharmacoeconomic studies indicate that tricyclic drugs and selective serotonin reuptake inhibitors have similar cost effectiveness in the health care systems where these comparisons have been made
Amitriptyline for inpatients and SSRIs for outpatients with depression? Systematic review and meta-regression analysis
No full textBackground: Although the selective serotonin reuptake inhibitors (SSRIs) are widely used as first-line agents in depression, amitriptyline, a reference tricyclic (TCA) agent, has the edge in terms of efficacy over control antidepressants (ADs), but it is not clear whether this advantage can be attributed to a more favourable profile in inpatients, but not in outpatients, with depression. The aim of this study was to investigate the contribution of study setting on outcome in clinical trials comparing amitriptyline with any other AD. Methods: A systematic review and meta-regression analysis of amitryptiline randomised clinical trials was carried out. The electronic search yielded 181 randomised clinical trials, 47% enrolling inpatients and 53% outpatients with depression. Results: Both on a dichotomous and continuous outcome, amitriptyline was more effective than control agents in inpatients [Peto odds ratio (OR): 1.22, 95%, Confidence Interval (CI): 1.04, 1.42; Standardised Mean Difference (SMD): 0.28, 95%, CI: 0.08, 0.46], but not in outpatients (Peto OR: 1.01, 95%, CI: 0.88, 1.17; SMD: 0.10, 95% CI: -0.02, 0.23). Among inpatients amitriptyline was significantly more effective than TCA and nonsignificantly more effective than the SSRIs. Among outpatients no statistically significant differences emerged between amitriptyline and TCA and between amitriptyline and the SSRIs. Amitriptyline was less well tolerated than control agents in outpatients (Peto OR: 0.90, 95%, CI: 0.81, 0.99), but not in inpatients (Peto OR: 1.09, 95% CI: 0.95, 1.25). Conclusions: These data suggest that a reasonable approach could be the first-line prescription of newer agents in the routine outpatient care of depressive subjects, and the use of amitriptyline in inpatients with severe depression
Revisioni sistematiche e decisioni cliniche in psichiatria
No full textIn psichiatria, ormai da alcuni anni, accanto alle revisioni classiche della letteratura, le cosiddette revisioni narrative, gli articoli cioè in cui gli esperti di ciascun settore passano in rassegna le conoscenze riguardanti un determinato argomento per trarne conclusioni utili alia pratica clinica, si è progressivamente affermato un nuovo tipo di rassegna della letteratura, denominato revisione sistematica. Questo è avvenuto a seguito dell'altrettanto forte affermazione dell'idea secondo cui le decisioni in medicina devono basarsi sulle evidenze scientifiche a nostra disposizione. Le evidenze scientifiche sono meglio dette prove di efficacia, e il termine che descrive questo movimento è medicina basata sulle prove di efficacia (Barbui et al, 2002). Secondo il paradigma della medicina basata sulle prove di efficacia (o evidence-based medicine, da cui la sigla EBM) le revisioni sistematiche rappresentano lo strumento piu idoneo per riassumere le prove di efficacia esistenti per ogni argomento. Scopo di questo editoriale è chiarire che cosa sono le prove di efficacia in medicina ed esemplificare come queste ultime vengono correntemente utilizzate nella preparazione e nel mantenimento delle revisioni sistematiche. Obiettivo ultimo è discutere il possibile ruolo delle revisioni sistematiche nel supportare il processo di acquisizione di competenze che permettano di prendere decisioni in ambito psichiatrico.</jats:p
Fluoxetine dose and outcome in antidepressant drug trials
No full textObjective: One potential for bias in the evaluation of a new drug is the dose used, both for the new compound and for the reference drug. The present study compared fluoxetine dose and outcome in trials in which fluoxetine was the experimental drug with trials in which it was the comparator.
Methods: Systematic review of randomised controlled trials comparing fluoxetine with any other antidepressant in depressive patients. Studies were allocated to one of the following two groups: group 1 = fluoxetine was the experimental drug; group 2 = fluoxetine was the control drug. Trials were located by searching the Cochrane Collaboration Depression, Anxiety and Neurosis Controlled Trials Register and the Cochrane Controlled Trials Register.
Results: The systematic search yielded 103 randomised trials. Studies in which fluoxetine was the experimental drug adopted a higher dose regimen than group-2 studies. In the efficacy analysis, the weighted rate of fluoxetine responders was 70.1% (confidence interval 67.4%, 72.8%) in group-1 studies and 57.9% (57.2%, 58.7%) in group-2 studies. In the effectiveness analysis, the weighted rate of fluoxetine responders was 56.4% (55.3%, 57.6%) in group-1 studies and 51.9% (51.2%, 52.7%) in group-2 studies. The weighted rate of fluoxetine dropouts was higher in group-1 studies.
Conclusion: Fluoxetine dose and outcome changed according to whether this drug was used as a new compound or as a reference
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