Selective serotonin reuptake inhibitors and tricyclic antidepressants in the acute treatment of chronic depression and dysthymia: A systematic review and meta-analysis

Wolff, Alessa von; Hölzel, Lars P.; Westphal, Annika; Härter, M.; Kriston, Levente

doi:10.1016/j.jad.2012.06.007

Cited by 102 publications

(57 citation statements)

References 34 publications

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“…136 These results confirmed a meta-analysis (20 trials, N ¼ 2918) of chronic depression showing that SSRIs were similar in efficacy but superior in tolerability compared with TCAs. 137 The network meta-analysis also identified differences in effects between combined psychotherapy þ medication and medication-only studies in dysthymia studies compared to studies of chronic MDD, suggesting that the new diagnosis of PDD may not have homogeneous treatment response. 136 Although there are positive results in treating chronic depression and PDD with antidepressants, some experts have argued that patients with repeated treatment failures and a chronic course of depression require a chronic disease management approach (i.e., with less emphasis on remission of symptoms and cure, greater emphasis on improving functioning and quality of life, and greater use of psychotherapeutic and nonmedication treatments).…”

Section: How Do You Manage Persistent and Chronic Depression?mentioning

confidence: 99%

Canadian Network for Mood and Anxiety Treatments (CANMAT) 2016 Clinical Guidelines for the Management of Adults with Major Depressive Disorder

et al. 2016

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Background: The Canadian Network for Mood and Anxiety Treatments (CANMAT) conducted a revision of the 2009 guidelines by updating the evidence and recommendations. The scope of the 2016 guidelines remains the management of major depressive disorder (MDD) in adults, with a target audience of psychiatrists and other mental health professionals. Methods: Using the question-answer format, we conducted a systematic literature search focusing on systematic reviews and meta-analyses. Evidence was graded using CANMAT-defined criteria for level of evidence. Recommendations for lines of treatment were based on the quality of evidence and clinical expert consensus. ''Pharmacological Treatments'' is the third of six sections of the 2016 guidelines. With little new information on older medications, treatment recommendations focus on second-generation antidepressants.Results: Evidence-informed responses are given for 21 questions under 4 broad categories: 1) principles of pharmacological management, including individualized assessment of patient and medication factors for antidepressant selection, regular and

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Section: How Do You Manage Persistent and Chronic Depression?mentioning

confidence: 99%

Canadian Network for Mood and Anxiety Treatments (CANMAT) 2016 Clinical Guidelines for the Management of Adults with Major Depressive Disorder

et al. 2016

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“…Our findings are comparable to several studies that have found TCAs and SSRIs have equal efficacy. [13][14][15][16] Therefore, it can be concluded that amitriptyline and escitalopram are effective in the treatment of depression and the efficacy of escitalopram is equivalent to amitriptyline in Nepalese population.…”

Section: Discussionmentioning

confidence: 99%

“…8,10,11 The AD efficacy of SSRIs has been well documented, but the comparative study has shown superior efficacy of escitalopram to conventional SSRIs. 6,[10][11][12][13] Comparative clinical trials indicate that SSRIs are as effective as TCAs, but relative safety and better acceptability of SSRIs has been the reason to their clinical success over TCAs. [13][14][15][16][17][18] However, published data evaluating and comparing the efficacy of different ADs are lacking in Nepal.…”

mentioning

confidence: 99%

“…6,[10][11][12][13] Comparative clinical trials indicate that SSRIs are as effective as TCAs, but relative safety and better acceptability of SSRIs has been the reason to their clinical success over TCAs. [13][14][15][16][17][18] However, published data evaluating and comparing the efficacy of different ADs are lacking in Nepal. This study was designed to compare the efficacy of escitalopram, most selective SSRIs with amitriptyline, a reference standard drug in the treatment of depression.…”

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confidence: 99%

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A comparative study on efficacy of amitriptyline and escitalopram in the treatment of depression

Aryal

Chakrabarti

Gupta

2018

Int J Basic Clin Pharmacol

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Background: Several generations of antidepressant medication which act by distinct pharmacological mechanisms have been introduced for the treatment of depression; tricyclic antidepressants (TCAs) were first line of treatment for many years. However, over the last decade, selective serotonin reuptake inhibitors (SSRIs) have displaced TCAs, mainly because of better side effect profile. There are no references in literature on comparison of efficacy of TCAs and SSRIs in Nepalese population. This study attempted to compare the efficacy of amitriptyline, a reference standard TCA with escitalopram, a newer SSRI in Nepalese population.Methods: An open level, randomised, prospective study was conducted for one year duration. Eighty outpatients suffering from major depression who met inclusion and exclusion criteria were randomly assigned to either amitriptyline or escitalopram group for four week study. Seventy one patients (amitriptyline N: 36, escitalopram N: 35) completed the study. Hamilton Depression Rating Scale (HDRS) was used to measure the antidepressant effect. Antidepressant efficacy was evaluated on reduction of HDRS score before and after therapy (End of four weeks).Results: In amitriptyline group, mean percentage reduction in HDRS score was 58.29% (13.5 points), while in escitalopram group was 60.78% (14.03 points). Both the drugs significantly improved the HDRS score at the end of the study (p<0.05). On intergroup comparison, antidepressant efficacy of amitriptyline and escitalopram did not differ significantly from each other (p>0.05).Conclusions: This study suggests that escitalopram is effective in the treatment of depression and its efficacy appears to be comparable to amitriptyline at the end of four weeks.

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“…2 A metaanalysis on combined treatments for depression, which is recommended in most treatment guidelines, included only 8 trials. 3 Considering the clinical and public health importance of chronic depression, research on this topic is needed.…”

mentioning

confidence: 99%

The Need for Research on Treatments of Chronic Depression

2017

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Selective serotonin reuptake inhibitors and tricyclic antidepressants in the acute treatment of chronic depression and dysthymia: A systematic review and meta-analysis

Cited by 102 publications

References 34 publications

Canadian Network for Mood and Anxiety Treatments (CANMAT) 2016 Clinical Guidelines for the Management of Adults with Major Depressive Disorder

Canadian Network for Mood and Anxiety Treatments (CANMAT) 2016 Clinical Guidelines for the Management of Adults with Major Depressive Disorder

A comparative study on efficacy of amitriptyline and escitalopram in the treatment of depression

The Need for Research on Treatments of Chronic Depression

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