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Low-Dosage Tricyclic Antidepressants Justified in Adult Depression
A DGReview of :"Meta-analysis of effects and side effects of low dosage tricyclic antidepressants in depression: systematic review."
British Medical Journal (BMJ)
11/11/2002
By Elda Hauschildt
Treating depressed adults with low-dose tricyclic antidepressants is justified, a meta-analysis of the literature up to November 2000 indicates.
An international team of researchers from Japan, British and Italy do suggest, however, that more rigorous studies are needed to definitively establish the relative benefits and harms of various dosages.
They concluded: "Low dosage tricyclic antidepressants between 75 mg/d 100 mg/d and possibly below this range bring about more reduction in depression at four to eight weeks of treatment and beyond, as well as more dropouts due to side effects and more people with at least one side effect, than placebo in both primary care and psychiatric settings."
They point out that standard dosage tricyclics may or may not be able to bring about more reduction in depression than low-dosage tricyclics but standard dosages cause more patients to drop out of treatment due to side effects than placebo does.
The systematic review of randomised trials included 35 studies with 2,013 participants that compared low-dosage tricyclics with placebo and six studies with 551 participants that compared low-dosage tricyclics with standard dosage tricyclics.
The researchers, from Nagoya City University Medical School in Japan, King's College Institute of Psychiatry in London and the University of Verona, found the low dosage tricyclics were 1.65 times more likely than placebo to bring about response at four weeks. At six to eight weeks, the low-dosage drugs were 1.47 times as likely as placebo to produce results.
They also say every trial protocol should include strategies for ensuring follow-up of every participant, even if the patient stops using the prescribed drug: "Only then can the relative benefits and harms of various dosages be definitely established."
BMJ, 2002: 325: 991-994.
"Meta-analysis of effects and side effects of low dosage tricyclic antidepressants in depression: systematic review."
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