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Tricyclics And Serotonin Reuptake Inhibitors Equally Effective In Treating Depression In Primary Care Setting
A DGReview of :"Efficacy and tolerability of selective serotonin reuptake inhibitors compared with tricyclic antidepressants in depression treated in primary care: systematic review and meta-analysis"
British Medical Journal (BMJ)
05/23/2003
By Emma Hitt, PhD
Serotonin reuptake inhibitors and tricyclic antidepressants appear to be equally effective in treating primary care patients for depression, although studies comparing the 2 drug classes are limited in number and of variable quality, according to British researchers
"Few reviews have focused only on comparing the 2 main classes of antidepressants -selective serotonin reuptake inhibitors and tricyclics-and none has previously done so for patients treated in primary care alone," Steve MacGillivray, MD, with the University of Dundee, United Kingdom and colleagues note.
The researchers conducted a systematic review and meta-analysis of randomised controlled trials included in the Register of the Cochrane Collaboration and other relevant review papers. They selected 11 studies involving 2951 participants. All selected studies compared a selective serotonin reuptake inhibitor with a tricyclic antidepressant in a primary care setting and met other criteria, including a predetermined sample size and clearly defined outcomes.
Efficacy between selective serotonin reuptake inhibitors and tricyclics was similar (p <0.11); however, significantly more patients receiving a tricyclic withdrew from treatment (p <0.0007), mostly due to side effects, they found.
Dr. MacGillivray and colleagues note that most studies included were small or supported by commercial funding. In addition, many studies lasted 8 weeks or less and were either of low methodological quality or did not present adequate data for analysis, or both.
According to the researchers, differences in tolerability of medicines may exist between patients treated in different settings, and "it may be appropriate for bodies that grant licences for drugs to ensure that studies have been carried out in appropriate settings before granting specific antidepressants their licence."
BMJ 2003 May 10;326(7397):1014.
"Efficacy and tolerability of selective serotonin reuptake inhibitors compared with tricyclic antidepressants in depression treated in primary care: systematic review and meta-analysis"
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