Alprazolam versus imipramine in depressed out-patients with neurovegetative signs

Goldberg, Solomon C.; Ettigi, Prakash; Schulz, Patricia M.; Hamer, Robert M.; Hayes, Peggy E.; Friedel, Robert O.

doi:10.1016/0165-0327(86)90020-0

Cited by 18 publications

(12 citation statements)

References 10 publications

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“…Dropout rates were estimated to be approximately similar for both medication classes in 4 studies [43,45,47,52]. However, in Hubain et al [52], a significantly greater number of alprazolam-treated patients dropped out of the study (due to ineffectiveness) than amitriptylinetreated patients.…”

Section: Systematic Review Of Rct On the Efficacy Of Bzd In The Treatmentioning

confidence: 99%

“…No withdrawal symptoms were observed by Ansseau et al [53] after tapered discontinuation of all medications, and Goldberg et al [43] reported only 1 case in which the abrupt discontinuation of alprazolam caused a seizure (withdrawal reactions were not systematically investigated).…”

Section: Systematic Review Of Rct On the Efficacy Of Bzd In The Treatmentioning

confidence: 99%

“…Fourteen reports compared BZD and TCA in the treatment of depression [41,42], major depressive disorder [43][44][45][46][47], and serious forms of endogenous depression [48][49][50][51][52][53] including 1 with melancholic characteristics [54] (online suppl. Table 1).…”

Section: Systematic Review Of Rct On the Efficacy Of Bzd In The Treatmentioning

confidence: 99%

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Benzodiazepines as a Monotherapy in Depressive Disorders: A Systematic Review

Benasi¹,

Guidi²,

Offidani³

et al. 2018

Psychother Psychosom

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Background: The aim of this paper was to perform a systematic review and, when feasible, a meta-analysis of randomized controlled trials (RCT) which used benzodiazepines (BZD) as a monotherapy versus placebo, antidepressant drugs (AD), or both. Methods: Keyword searches were conducted for identifying RCT comparing BZD and AD, and/or placebo in the treatment of depression, using electronic databases from their inception up to April 2017. We selected reports of RCT in which BZD were compared to AD and/or placebo in the treatment of adult patients with a primary diagnosis of depressive disorder or anxious depression. When feasible, data were subjected to meta-analysis. Results: A total of 38 studies met the criteria for inclusion and were then included in the systematic review. Only 1 study concerned a newer AD, fluvoxamine. For the meta-analysis, we submitted data on response rate from 22 RCT, considering BZD versus placebo (8 comparisons) and BZD versus tricyclic antidepressants (TCA) (20 comparisons). There was a lack of significant differences as to response rate between BZD and placebo, as well as between BZD and TCA. Analysis of individual studies disclosed that, in more than half of the studies comparing BZD to TCA and/or placebo, BZD were significantly more effective than placebo and as effective as TCA. Conclusions: BZD are a therapeutic option in anxious depression and there are no indications that AD are preferable. There is a pressing need for RCT of adequate methodological quality and follow-up comparing BZD to second-generation AD and placebo in anxious depression.

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Section: Systematic Review Of Rct On the Efficacy Of Bzd In The Treatmentioning

confidence: 99%

Section: Systematic Review Of Rct On the Efficacy Of Bzd In The Treatmentioning

confidence: 99%

See 1 more Smart Citation

Benzodiazepines as a Monotherapy in Depressive Disorders: A Systematic Review

Benasi¹,

Guidi²,

Offidani³

et al. 2018

Psychother Psychosom

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“…Clinical studies in depressed patients showed that alprazolam is at least equally effective as TCAs, such as amitriptyline (13,66,76,126,157,249), imipramine (84,86,87,180,212,277), dosulepine (41), desipramine (85,210), or doxepin (9). However, other studies reported that, although alprazolam provided symptom relief, amitriptyline (124,159,227) and imipramine (103,161) were significantly more effective. Analyses of early dropouts revealed that whether alprazolam or TCAs are the most favorable treatment choice depends on the diagnosis of depression (mild versus severe) (199).…”

Section: Depressionmentioning

confidence: 99%

Clinical Pharmacology, Clinical Efficacy, and Behavioral Toxicity of Alprazolam: A Review of the Literature

2004

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Alprazolam is a benzodiazepine derivative that is currently used in the treatment of generalized anxiety, panic attacks with or without agoraphobia, and depression. Alprazolam has a fast onset of symptom relief (within the first week); it is unlikely to produce dependency or abuse. No tolerance to its therapeutic effect has been reported. At discontinuation of alprazolam treatment, withdrawal and rebound symptoms are common. Hence, alprazolam discontinuation must be tapered. An exhaustive review of the literature showed that alprazolam is significantly superior to placebo, and is at least equally effective in the relief of symptoms as tricyclic antidepressants (TCAs), such as imipramine. However, although alprazolam and imipramine are significantly more effective than placebo in the treatment of panic attacks, Selective Serotonin Reuptake Inhibitors (SSRIs) appear to be superior to either of the two drugs. Therefore, alprazolam is recommended as a second line treatment option, when SSRIs are not effective or well tolerated. In addition to its therapeutic effects, alprazolam produces adverse effects, such as drowsiness and sedation. Since alprazolam is widely used, many clinical studies investigated its cognitive and psychomotor effects. It is evident from these studies that alprazolam may impair performance in a variety of skills in healthy volunteers as well as in patients. Since the majority of alprazolam users are outpatients, this behavioral impairment limits the safe use of alprazolam in patients routinely engaged in potentially dangerous daily activities, such as driving a car.

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“…Firstly, the benzodiazepines often improve â€˜¿ de pression scores' faster than true antidepressants in the first weeks of a study, but the antidepressant then produces a longer-lasting and superior effect (O'Shea, 1989 Thirdly, the definitions of depression have been flawed. Studies which used neurovegetative signs (Goldberg et a!, 1986) or reduced REM latencies (Rush et a!, 1985) (HRSD) scores in the diazepam group compared with the moclobemide group after one and four weeks of treatment. As a result, they concluded that diazepam was a better antidepressant than moclobemide in atypical depression.…”

mentioning

confidence: 99%

Is diazepam an antidepressant?-Letter by Brian O'Shea

O’Shea

1990

Br J Psychiatry

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Alprazolam versus imipramine in depressed out-patients with neurovegetative signs

Cited by 18 publications

References 10 publications

Benzodiazepines as a Monotherapy in Depressive Disorders: A Systematic Review

Benzodiazepines as a Monotherapy in Depressive Disorders: A Systematic Review

Clinical Pharmacology, Clinical Efficacy, and Behavioral Toxicity of Alprazolam: A Review of the Literature

Is diazepam an antidepressant?-Letter by Brian O'Shea

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