The treatment of depression in general practice: a comparison of L-tryptophan, amitriptyline, and a combination of L-tryptophan and amitriptyline with placebo

Thomson, J. Anderson; RANKiN, H. G.; Ashcroft, G. W.; Yates, Celia M.; McQueen, Judith K.; Cummings, Scott W.

doi:10.1017/s0033291700049047

Cited by 156 publications

(56 citation statements)

References 34 publications

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“…18,22,25,[27][28][29] A score of 0 on any component caused the study to be rated as being poor quality. …”

Section: Resultsmentioning

confidence: 99%

“…There were 890 participants in SSRI studies, 596 in TCA studies, and 1,267 patients on placebo (Table 1). [16][17][18][19][20][21][22][23][24][25][26][27][28][29][30] Of the 5 possible SSRIs available, 2 studied sertraline, 3 studied escitalopram (a precursor of citalopram), and 1 studied citalopram. Of the TCAs available, 2 studied dothiepin, 4 studied amitriptyline, 2 studied mianserin, and 3 studied imipramine.…”

Section: Resultsmentioning

confidence: 99%

“…We also performed a funnel plot analysis to check for publication bias. There were a number of defi nitions for outcomes we described as "improvement": 4 defi nitions used ≤50% reduction in the Montgomery-Asberg Depression Rating Scale (MADRS), [16][17][18][19] ≤50% reduction in Hamilton Depression Rating Scale (HAMD), 20 ≤7 on the HAMD scale, 21 and ≤4 points on HAMD 22 ; and 3 defi nitions used global evaluation of improvement.…”

Section: Data Synthesismentioning

confidence: 99%

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Efficacy and Tolerability of Tricyclic Antidepressants and SSRIs Compared With Placebo for Treatment of Depression in Primary Care: A Meta-Analysis

Arroll

MacGillivray²,

Ogston³

et al. 2005

The Annals of Family Medicine

299

166

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PURPOSE Depression is common in primary care. There are no systematic reviews of depression treatment comparing antidepressants with placebo; hence, we do not know whether these medications are effective in primary care. METHODSWe searched the Cochrane Collaboration Depression, Anxiety and Neurosis Group register of controlled trials, MEDLINE, International Pharmaceutical abstracts, PsycINFO, and EMBASE. Abstracts of potential studies were reviewed independently by 2 authors. Studies needed to include randomized controlled trials of either a tricyclic antidepressant (TCA) or selective serotonin reuptake inhibitor (SSRI), or both, and placebo in a primary care setting. The data and quality of the studies were extracted and assessed by 2 authors blind to the other's choice. Disagreements were resolved by discussion. The main outcome measures were the standardized mean difference and weighted mean difference of the fi nal mean depression scores, the relative risk of improvement, and the number withdrawing because of side effects. Pooling of results was done using Review Manager 4.2.2.RESULTS There were 10 studies in which TCAs were compared with placebo, 3 in which SSRIs were compared with placebo, and 2 with both compared with placebo. One half of the studies were of low methodological quality, and nearly all studies were of short duration, typically 6 to 8 weeks. Pooled estimates of effi cacy data showed a relative risk of 1.26 (95% CI, 1.12-1.42) for improvement with TCAs compared with placebo; For SSRIs, relative risk was 1.37 (95% CI, 1.21-1.55). Most patients, 56% to 60%, responded well to active treatment compared with 42% to 47% for placebo. The number needed to treat for TCAs was about 4, and for SSRIs it was 6. The numbers needed to harm (for withdrawal caused by side effects) ranged from 5 to 11 for TCAs and 21 to 94 for SSRIs. Low-dose (100 mg or 75 mg) as well as high-dose TCAs were effective.CONCLUSION This systematic review is the fi rst comparing antidepressants with placebo for treatment of depression in primary care. Both TCAs and SSRIs are effective. This review is also the fi rst to show that low-dose TCAs are effective in primary care. Prescribing antidepressants in primary care is a more effective clinical activity than prescribing placebo. Doubts about the effectiveness of antidepressant medication and other therapies, such as cognitive therapy, may contribute to the variability in primary care management of depression.3,4 Up to 40% of depressed patients fail to show a response to fi rst-line antidepressant drug treatment, 5 and of those that do respond, only a proportion will achieve full recovery.6 One cohort study of primary care patients found that 60% of depressed patients treated with medication and 50% with milder depression still met the criteria for caseness at 1 year. 7Recent reports have indicated an urgent need to review the evidence of only those studies of antidepressant effi cacy on patient samples based in primary care. 8,9 Several completed reviews and protocols are c...

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“…18,22,25,[27][28][29] A score of 0 on any component caused the study to be rated as being poor quality. …”

Section: Resultsmentioning

confidence: 99%

Section: Resultsmentioning

confidence: 99%

Section: Data Synthesismentioning

confidence: 99%

See 1 more Smart Citation

Efficacy and Tolerability of Tricyclic Antidepressants and SSRIs Compared With Placebo for Treatment of Depression in Primary Care: A Meta-Analysis

Arroll

MacGillivray²,

Ogston³

et al. 2005

The Annals of Family Medicine

299

166

View full text Add to dashboard Cite

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“…TRP has been successfully used to treat some cases of depression [3] and was found to enhance the effects of other antidepressive therapies [4]. In mild to moderate depression, TRP (3 g/ day) was found to be as effective as amitriptyline [5,6].…”

Section: Introductionmentioning

confidence: 99%

Acute Antidepressant-Like and Antianxiety-Like Effects of Tryptophan in Mice

Wong

Ong

2001

Pharmacology

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The antidepressant-like, antianxiety-like and sedative effects of tryptophan (TRP), in the absence and presence of p-chlorophenylalanine (p-CPA), and melatonin were studied in mice using the forced-swimming test, open-field test and activity cage, respectively. Single-dose TRP caused an antidepressant-like effect dose dependently up to 125 mg/kg. No significant effect was observed, however, when the TRP dose was increased to 250 mg/kg, i.e. a reversal of effect occurred at high dose. With p-CPA pretreatment, the effects observed at 125 and 250 mg/kg TRP were similar to those obtained at 50 and 125 mg/kg without p-CPA pretreatment, respectively. Melatonin also caused an antidepressant-like effect in a similar manner, but appeared to be less potent than TRP. These results strongly indicate that the antidepressant-like effect of TRP was due to its conversion to 5-hydroxytryptamine (5-HT). An antianxiety-like effect was observed for TRP only at 250 mg/kg dose together with p-CPA pretreatment, while no sedative effect was observed at all. In contrast, melatonin did not produce any antianxiety-like effect, but produced sedation at 200 mg/kg dose. It may be concluded that the antianxiety-like effect of TRP is unrelated to 5-HT and melatonin formation, but associated with TRP itself or, perhaps, with other anxiolytic metabolites.

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“…This dose of tryptophan is about three times the normal daily dietary intake, which is about 1 g/day (Sainio et al 1996). The 3g daily dose was chosen because (i) this dose should keep tryptophan hydroxylase close to saturation, and thus serotonin synthesis maximized, for most of the day (Young and Gauthier 1981), and (ii) the same dosage, when given to mild to moderately depressed outpatients, was more effective than placebo in treating depression, but produced no more side effects than placebo (Thomson et al 1982). Tryptophan was given with meals for two reasons.…”

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confidence: 99%

The Effect of Tryptophan on Social Interaction in Everyday Life A Placebo-Controlled Study

Moskowitz

Pinard

Zuroff

et al. 2001

Neuropsychopharmacology

134

100

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In monkeys increasing serotonin function enhances affiliative interactions and promotes the acquisition of dominance. To examine whether similar effects occur in humans, we treated 98 subjects for 12 days with the serotonin precursor tryptophan (1g TID) and for 12 days with placebo in a doubleThe quality and nature of social interactions are defining features of both mental health and psychiatric disorders, but the tools used to study social interaction in psychopharmacological research generally examine global functioning rather than specific aspects of social interaction. Social science research in this area has advanced greatly over the past decade, and it is possible to conceptualize major components of social interaction and how these components are interrelated. While details vary, typically interpersonal behaviors can be organized in a circle defined by two major axes (Carson 1969;Foa 1961;Kiesler 1983;Leary 1957;Wiggins 1995;Wiggins and Broughton 1985). One axis encompasses dominant and submissive behaviors. This axis has been called by various names including agency, power, and status. Dominant behaviors include setting goals for others or telling others to do something while submissive behaviors include not voicing an opinion or waiting for others to act (Moskowitz 1994). The second axis encompasses agreeable and quarrelsome behaviors. Sample agreeable behaviors include listening attentively to others and expressing reassurance while quarrelsome behaviors include showing impatience and making sarcastic comments (Moskowitz 1994). Among many labels, this axis has been referred to as communion or affiliation.The two axes of human social interaction can be studied using an event sampling method. This method assesses individuals' social behaviors and affect in individuals' natural environments rather than in the laboratory. The individual completes a brief questionnaire after each significant social interaction, throughout the 25 , NO . 2 day. Abundant evidence has accumulated demonstrating the reliability and validity of methods for sampling interpersonal behavior and affect in everyday life (Csikszentmihalyi and Larson 1987;Diener and Emmons 1984;McAdams and Constantian 1983;Moskowitz 1994). While behavior along the axes varies greatly from one social interaction to the next, aggregation of behaviors in events across several days provides measures with substantial temporal stability (Brown and Moskowitz 1998). The event-contingent recording procedure (Wheeler and Reis 1991) used in the present study has several advantages. Interpersonal situations are sampled throughout the day, providing reports of behavior and affect at home and at work. Reports of behavior and affect are recorded close in time to their occurrence, so retrospective biases are minimized. It is possible to construct behavior and affect scores for time periods of specified lengths, such as morning, afternoon, and evening, or a day, or a week. Previous research using this method has demonstrated the concurrent relation between interper...

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The treatment of depression in general practice: a comparison of L-tryptophan, amitriptyline, and a combination of L-tryptophan and amitriptyline with placebo

Cited by 156 publications

References 34 publications

Efficacy and Tolerability of Tricyclic Antidepressants and SSRIs Compared With Placebo for Treatment of Depression in Primary Care: A Meta-Analysis

Efficacy and Tolerability of Tricyclic Antidepressants and SSRIs Compared With Placebo for Treatment of Depression in Primary Care: A Meta-Analysis

Acute Antidepressant-Like and Antianxiety-Like Effects of Tryptophan in Mice

The Effect of Tryptophan on Social Interaction in Everyday Life A Placebo-Controlled Study

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