DOCSLIB.ORG

Still the Leading Antidepressant After 40

Total Page：16

File Type：pdf, Size：1020Kb

Download full-text PDF Read full-text
Still the Leading Antidepressant After 40 BRITISH JOURNAL OF PSYCHIATRY "2001), 178, 129^144 REVIEW ARTICLE Amitriptyline vv.therest:stilltheleading METHOD Inclusion criteria antidepressant after 40 years of randomised All RCTs comparing amitriptyline with any y other tricyclic,heterocyclic or SSRI were in- controlled trials cluded. Crossover studies were excluded. Studies adopting any criteria to define CORRADO BARBUI and MATTHEW HOTOPF patients suffering from depression were included; a concurrent diagnosis of another psychiatric disorder was not considered an exclusion criterion. Trials in patients with depression with a concomitant medical ill- Background Tricyclic antidepressants Amitriptyline is one of the first `reference' ness were not included in this review. have similar efficacy and slightly lower tricyclic antidepressants TCAs). Over the past 40 years a number of newer tricyclics, tolerability than selective serotonin Search strategy heterocyclics and selective serotonin re- Relevant studies were located by searching reuptakeinhibitorsreuptake inhibitors SSRIs).However, uptake inhibitors SSRIs) have been intro- the Cochrane Collaboration Depression, there are no systematic reviews assessing duced Garattini et aletal,1998). Despite Anxiety and Neurosis Controlled Trials several large systematic reviews comparing amitriptyline, the reference tricyclic drug, Register CCDANCTR). This specialised tricyclics and SSRIs there is no clear agree- vv. other tricyclics and SSRIs directly. register is regularly updated by electronic ment over first-line treatment of depression Medline,Embase,PsycINFO,LILACS, SongSong et aletal,1993; Anderson & Tomenson, Aims ToreviewTo review the tolerability and Psyndex,CINAHL,SIGLE) and non-electro- 1995; Montgomery & Kasper,1995; efficacy of amitriptyline inthe nicnicliterature searches. The register was HotopfHotopf et aletal,1996; Canadian Coordinating management of depression. searched using the following terms: Office for Health Technology Assessment, AMITRIPTYLIN**AMITRIPTYLIN oror AMITRILAMITRIL oror ELA-ELA- 19971997aa). Grouped as a whole,tricyclics MethodMethod Asystematic review of TROLTROL oror ELAVILELAVIL oror EMITRIPEMITRIP oror ENDEPENDEP appear to have similar efficacy to SSRIs, oror ENOVILENOVIL oror LAROXYL oror LENTIZOL randomised controlled trials RCTs) but are slightly less well tolerated. If toler- oror LEVATELEVATE oror MEVARILMEVARIL oror NOVOTRIP- comparing amitriptyline with other ability is measured according to the TYNTYN oror SAROTENSAROTEN oror TRYPTALTRYPTAL oror numbers of drop-outs occurring in random- tricyclics/heterocyclics or with an SSRI. TRYPTIZOL oror TRIPTAFEN*.TRIPTAFEN*. A specific ised controlled trials RCTs),the number electronic search was also performed with ResultsResults Wereviewed186 RCTs.The needed to treat NNT) with SSRIs to Medline and Embase from 1966 to 1998. prevent one tricyclic-related drop-out is overallestimate ofthe efficacy of We used the search term: AMITRIP-AMITRIP- estimated at 33 Anderson & Tomenson, amitriptyline revealed a standardised TYLINETYLINE andand RANDOMISED CON- 1995). This modest advantage has to be mean difference of 0.147 95% CI 0.05^ TROLLED TRIAL oror RANDOM ALLO- set against the increased cost of SSRIs CATIONCATION oror DOUBLE-BLIND METHOD..METHOD 0.243), significantly favouring Canadian Coordinating Office for Health Reference lists of relevant papers and pre- Technology Assessment,1997 bb). A meta-meta-).A amitriptyline.The overall OR for dropping vious systematic reviews were hand analysis which subdivided TCAs according out was 0.99 95% CI 0.91^1.08) and that searched for published reports and citations to whether they were reference compounds for side-effects was 0.62 95% CI 0.54^ of unpublished research. Finally,attempts e.g. the oldest TCAs,amitriptyline and were made to obtain data through direct 0.70), favouring the control drugs.With imipramine) or newer tricyclics or hetero- contact with the pharmaceutical industry. drop-outsincluded as treatmentfailures, cyclics,suggested that the higher drop-out thetheestimateoftheeffectivenessof estimate ofthe effectiveness of rates associated with tricyclics could be Outcomes amitriptyline vv. tricyclics/heterocyclics and attributed to the effect of amitriptyline and imipramine ± newer tricyclics and Efficacy was evaluated using the following SSRIs showed a 2.5% difference in the heterocyclics were no worse than the SSRIs outcome measures: proportion of responders in favour of HotopfHotopf et aletal,1997). However,there have a)a)NumberNumber of patients who responded to amitriptyline number needed to treat 40, not been any systematic reviews assessing treatment out of the total number of CI 21^694;21^694;OR1.12 OR1.12 95% CI1.01^1.24)). amitriptyline v.v. other tricyclics and hetero- randomised patients. cyclics directly. We therefore aimed to test Conclusions Amitriptyline is less well the hypothesis that amitriptyline would be b)b)GroupGroup mean scores at the end of the trial on Hamilton Depression Rating tolerated thantricyclics/heterocyclics and less well tolerated than other tricyclics and SSRIs,and also to assess its effective- Scale HDRS; Hamilton,1960),or SSRIs, but slightly more patients treated Montgomery and AAsbergÊ sberg Depression ness compared with the alternatives. on it recover than on alternative Scale MADRS; Montgomery & Ê antidepressants. AAsberg,1979),orsberg,1979),or any other depression scale.scale. Declaration of interest None.None. Tolerability was evaluated using the ySee editorial, pp. 99^100, thisissue. following outcome measures: 129129 Downloaded from https://www.cambridge.org/core. 02 Oct 2021 at 06:38:45, subject to the Cambridge Core terms of use. BARBUI & HOTOPF a)a)NumberNumber of patients failing to complete inevitably excluded most drop-out patients. nortriptyline in combination with fluphena- the study as a proportion of the total Therefore,scores from continuous out- zine. One trial compared amitriptyline with number of randomised patients. comes were analysed on an end-point basis, nortriptyline plus fluphenazine. including only patients with a final assess- Although all trials reported that b)b)NumberNumber of patients complaining of ment or with an LOCF to the final assess- patients had been randomly allocated,in side-effects out of the total number of ment. Tolerability data were analysed by six cases the concealment of allocation randomised patients. calculating the proportion of patients who was inadequate with some bias possible. failed to complete the study and who In four studies only physicians,but not Data extraction experienced adverse reactions out of the patients,were blind to treatments,in nine total number of randomised patients. For cases neither physicians nor patients were Using a standard form two reviewers inde- each outcome measure three separate blind,while the other 173 studies were pendently extracted information on the year meta-analyses were planned. The firstThefirst double-blind. The median sample size was of publication,concealment of allocation, compared amitriptyline with tricylic/hetero- 50 patients 10% percentile 24,25% per- blindness,length of treatment,inclusion cri- cyclic antidepressants,the second amitripty-amitripty- centile 40,75% percentile 80,90% percen- teria,age range,country and setting of the line with SSRIs and the third analysis tile 153; range 10±531). The median length study and type of pharmacologicalpharmacological interven- summarised the overall comparison of ami- of trials was four weeks 25% percentile 4, tion. The number of patientsundergoing the triptyline with both tricyclic/heterocyclic 50% percentile 4,75% percentile 6; range randomisation procedure,the number of drugs and SSRIs. 3±12); the number of studies with more patients who failed to complete the study Dichotomous outcomes were sum- than four weeks of follow-up increased drop-outs) and that of patients complain- marised by calculating a Peto-weighted from 28 30%) to 62 67%) after 1980. ing of side-effects were recorded. For odds ratio for each study,together with In 67 trials 36%) authors adopted diag- dichotomous outcomes the number of the 95% CI. An overall odds ratio was then nostic criteria and a specification of severity patients showing a 50% reduction in score calculated as a summary measure. The of depression to enrol patients; in 55 trials on the HDRS or MADRS scale was ex- number of patients who need to be treated 30%) authors adopted only a specification tracted; if these figures were not available, NNT) with amitriptyline rather than the of severity,while in the remaining 34% of we extracted the number of patients cate- control antidepressants for one additional studies patients were enrolled on the basis gorised as `much improved' and `improved' patient to benefit NNTB) or be harmed of physicians' implicit criteria to define on the Clinical Global Impression scale NNTH) was calculated with the 95% CI patients with depression or because they CGI; Guy,1976),or the number of patients Altman,1998). Heterogeneity of treatment were judged to require antidepressant in the corresponding categories of any other effects between studies was tested using the therapy. Fifty-nine per cent of studies pub- rating scale if the CGI was not used. For ww22 statistic. Continuous outcomes were lished before 1980 used implicit criteria vv.. continuous outcomes the mean scores at analysed by calculating a standardised 9.6% of those published after this date. end-point on the HDRS and the number weighted mean difference SMD) for each Overall,108 trials
Load more

Recommended publications
  • (12) Patent Application Publication (10) Pub. No.: US 2005/0065218A1 Migeon Et Al
    US 2005.0065218A1 (19) United States (12) Patent Application Publication (10) Pub. No.: US 2005/0065218A1 Migeon et al. (43) Pub. Date: Mar. 24, 2005 (54) UTILIZATION OF ALVERINE, ALONE OR IN (30) Foreign Application Priority Data COMBINATION WITH TRICYCLC ANTDEPRESSANT OR A SPECIFIC Jun. 13, 2003 (FR).............................................. O307176 SEROTONIN REUPTAKE INHIBITOR FOR Apr. 30, 2004 (FR).............................................. O404639 THE TREATMENT OF DEPRESSION Publication Classification (76) Inventors: Jacques Migeon, Seattle, WA (US); Frederic Revah, Paris (FR) (51) Int. C.7 - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - A61K 31/137 (52) U.S. Cl. .............................................................. 514/649 Correspondence Address: SESD LARDNER (57) ABSTRACT 3000 KSTREET NW WASHINGTON, DC 20007 (US) The present invention relates to the utilization of Alverine or its metabolites, alone or in combination with a tricyclic (21) Appl. No.: 10/866,079 antidepressant or a Specific Serotonin reuptake inhibitor, for the preparation of pharmaceutical compositions for the (22) Filed: Jun. 14, 2004 treatment of depression. 80 120 OO 8 O 6 O 40 20 t Excipicnts Alverine Alverine Alverine Imiprannine (1% methylcellulose) Citate Citrate Citrate 10 mg/kg 3 mg/kg 10 mg/kg 30 mg/kg Patent Application Publication Mar. 24, 2005 Sheet 1 of 4 US 2005/0065218 A1 Excipients Alverine Alveline Alveline Inipramine (1% methylcellulose) Citrate Citrate Citrate 10 mg/kg 3 mg/kg 10 mg/kg 30 mg/kg Fi gure US 2005/0065218A1 Imipramine 30 mg/kg Figure 2 Patent Application Publication Mar. 24, 2005 Sheet 3 of 4 US 2005/0065218A1 20 Vehicle + Whicule -- Averine Alvérine Vehicule + Alverine Vehicule imipramine 3 ring/kg it 3 mg/kg t- Impramine 10 mg/kg + 3 mg/kg Wellicule imipramine 10 mg/kg Vehicule 3 mg/kg Figure 3 Patent Application Publication Mar.
    [Show full text]
  • 2019 Instrumentation and Consumable Catalog 2 INSTRUMENTATION and CONSUMABLE CATALOG
    PRODUCT CATALOG 2019 Instrumentation and Consumable Catalog 2 INSTRUMENTATION AND CONSUMABLE CATALOG Resolvex® A200 Part Numbers: A200 96: 253-1160 Resolvex® A200 96 Resolvex A200 Standalone work station for automated sample preparation. The compact benchtop offers the one stop solution for automating sample preparation utilizing creation of multiple work flows, and programmable dispensing of up to 11 solvents. Along with its innovative positive pressure system leading to clean samples, improving accuracy, throughput and enhancing the Life time of your analytical instrument. The A200 comes with an easy to use touch screen interface allowing for easy set up of multiple work flows. In addition the light curtain safety feature will release gas pressure when manifold is activated to prevent any injuries. INSTRUMENTATION AND CONSUMABLE CATALOG 3 Resolvex® A100 Part Numbers: A100 96: 253-0019 A100 48: 253-0014 Resolvex® A100 Standalone work station for automated sample preparation. The compact benchtop offers the one stop solution for automating sample preparation utilizing creation of multiple work flows, and programmable dispensing of up to 11 solvents. Along with its innovative positive pressure system leading to clean samples, improving accuracy, throughput and enhancing the Life time of your analytical instrument. The A100 comes in 96 and 4 configuration allowing for for automated Work Flow solutions in multiple SPE formats. 4 INSTRUMENTATION AND CONSUMABLE CATALOG Resolvex® M10 96/M10 96 XT/M10 48 Part Numbers: M10 96 XT: 288-0006 M10 96: 288-0001 M10 48: 289-0004 Resolvex® M10 Standalone work station for Positive Pressure solid phase extraction. The manual Resolvex M10 48 and 96 are positive pressure manifold for 1, 3, and 6 ml cartridges, or 1ml 96 well plates.
    [Show full text]
  • Still the Leading Antidepressant After 40 Years of Randomised Controlle
    BRITISH JOURNAL OF PSYCHIATRY "2001), 178, 129^144 REVIEW ARTICLE Amitriptyline vv.therest:stilltheleading METHOD Inclusion criteria antidepressant after 40 years of randomised All RCTs comparing amitriptyline with any y other tricyclic,heterocyclic or SSRI were in- controlled trials cluded. Crossover studies were excluded. Studies adopting any criteria to define CORRADO BARBUI and MATTHEW HOTOPF patients suffering from depression were included; a concurrent diagnosis of another psychiatric disorder was not considered an exclusion criterion. Trials in patients with depression with a concomitant medical ill- Background Tricyclic antidepressants Amitriptyline is one of the first `reference' ness were not included in this review. have similar efficacy and slightly lower tricyclic antidepressants TCAs). Over the past 40 years a number of newer tricyclics, tolerability than selective serotonin Search strategy heterocyclics and selective serotonin re- Relevant studies were located by searching reuptakeinhibitorsreuptake inhibitors SSRIs).However, uptake inhibitors SSRIs) have been intro- the Cochrane Collaboration Depression, there are no systematic reviews assessing duced Garattini et aletal,1998). Despite Anxiety and Neurosis Controlled Trials several large systematic reviews comparing amitriptyline, the reference tricyclic drug, Register CCDANCTR). This specialised tricyclics and SSRIs there is no clear agree- vv. other tricyclics and SSRIs directly. register is regularly updated by electronic ment over first-line treatment of depression Medline,Embase,PsycINFO,LILACS, SongSong et aletal,1993; Anderson & Tomenson, Aims ToreviewTo review the tolerability and Psyndex,CINAHL,SIGLE) and non-electro- 1995; Montgomery & Kasper,1995; efficacy of amitriptyline inthe nicnicliterature searches. The register was HotopfHotopf et aletal,1996; Canadian Coordinating management of depression. searched using the following terms: Office for Health Technology Assessment, AMITRIPTYLIN**AMITRIPTYLIN oror AMITRILAMITRIL oror ELA-ELA- 19971997aa).
    [Show full text]
  • Tcas Versus Placebo - New Studies in the Guideline Update
    TCAs versus placebo - new studies in the guideline update Comparisons Included in this Clinical Question Amitriptyline vs placebo Clomipramine vs placebo Dosulepin (dothiepin) vs placebo AMSTERDAM2003A LARSEN1989 FERGUSON1994B BAKISH1992B PECKNOLD1976B ITIL1993 BAKISH1992C RAMPELLO1991 MINDHAM1991 BREMNER1995 THOMPSON2001B CLAGHORN1983 CLAGHORN1983B FEIGHNER1979 GELENBERG1990 GEORGOTAS1982A GOLDBERG1980 HICKS1988 HOLLYMAN1988 HORMAZABAL1985 HOSCHL1989 KLIESER1988 LAAKMAN1995 LAPIERRE1991 LYDIARD1997 MYNORSWALLIS1995 MYNORSWALLIS1997 REIMHERR1990 RICKELS1982D RICKELS1985 RICKELS1991 ROFFMAN1982 ROWAN1982 SMITH1990 SPRING1992 STASSEN1993 WILCOX1994 16 Imipramine vs placebo BARGESCHAAPVELD2002 BEASLEY1991B BOYER1996A BYERLEY1988 CASSANO1986 CASSANO1996 CLAGHORN1996A COHN1984 COHN1985 COHN1990A COHN1992 COHN1996 DOMINGUEZ1981 DOMINGUEZ1985 DUNBAR1991 ELKIN1989 ENTSUAH1994 ESCOBAR1980 FABRE1980 FABRE1992 FABRE1996 FEIGER1996A FEIGHNER1980 FEIGHNER1982 FEIGHNER1983A FEIGHNER1983B FEIGHNER1989 FEIGHNER1989A FEIGHNER1989B FEIGHNER1989C FEIGHNER1992B FEIGHNER1993 FONTAINE1994 GELENBERG2002 GERNER1980B HAYES1983 ITIL1983A KASPER1995B KELLAMS1979 LAIRD1993 LAPIERRE1987 LECRUBIER1997B LIPMAN1986 LYDIARD1989 MARCH1990 17 MARKOWITZ1985 MENDELS1986 MERIDETH1983 Nortriptyline vs placebo NANDI1976 GEORGOTAS1986A NORTON1984 KATZ1990 PEDERSEN2002 NAIR1995 PESELOW1989 WHITE1984A PESELOW1989B PHILIPP1999 QUITKIN1989 RICKELS1981 RICKELS1982A RICKELS1987 SCHWEIZER1994 SCHWEIZER1998 SHRIVASTAVA1992 SILVERSTONE1994 SMALL1981 UCHA1990 VERSIANI1989 VERSIANI1990
    [Show full text]
  • Treatment Resistant Depression Clinic Clinician Referral Form
    Treatment Resistant Depression Clinic Clinician Referral Form Patient Date: Name: Contact DOB: Sex: No: Ref. By: Contact: **Treating Contact: Psychiatrist: Primary Please Include Copy of Patient’s Insurance Insurance Card (Front and Back) Provider: PSYCHIATRIC NOTES How long have you known this patient? Current Diagnosis/Diagnoses: Current/Target Symptoms Past History of ECT □NO □YES If YES, # of sessions: Type: □UL □BF □BT Dates: Past response: □excellent □good □fair □poor □unknown Past History of TMS □NO □YES If YES, # of sessions: Dates: Past response: □excellent □good □fair □poor □unknown Current Medications: Current Medical Problems Emory Treatment Resistant Depression Clinic Clinician Referral Form 10/07/15 Allergies Do we have permission to contact the patient? □NO □YES ADDITIONAL NOTES Clinical Impression : Please complete the attached medication history form Include a copy of the patient’s insurance card (front and back) Fax referral form to: 404 712 7436. Attn: Emory TRD Clinic If you have any questions, please contact: Taelar Johnson at 404 712 8732 Emory Treatment Resistant Depression Clinic Clinician Referral Form 10/07/15 Generic Date drug How many weeks drug Drug Class Name was tried Min. Dose Max Dose Dosage was taken? Was it helpful?/Side Effects TCA Adapin Doxepin 150mg/d 250mg/d Anafranil Clomipramine 150mg/d 250mg/d Asendin Amoxapine 150mg/d 250mg/d Endep/Elavil Amitriptyline 150mg/d 250mg/d Ludiomil Maprotiline 150mg/d 250mg/d Norpramin Desipramine 150mg/d 250mg/d Pamelor Nortyrptiline 75mg/d 125mg/d Sinequin Doxepin
    [Show full text]
  • 1 Supplemental Figure 1: Illustration of Time-Varying
    Supplemental Material Table of Contents Supplemental Table 1: List of classes and medications. Supplemental Table 2: Association between benzodiazepines and mortality in patients initiating hemodialysis (n=69,368) between 2013‐2014 stratified by age, sex, race, and opioid co‐dispensing. Supplemental Figure 1: Illustration of time‐varying exposure to benzodiazepine or opioid claims for one person. Several sensitivity analyses were performed wherein person‐day exposure was extended to +7 days, +14 days, and +28 days beyond the outlined periods above. 1 Supplemental Table 1: List of classes and medications. Class Medications Short‐acting benzodiazepines Alprazolam, estazolam, lorazepam, midazolam, oxazepam, temazepam, and triazolam Long‐acting benzodiazepines chlordiazepoxide, clobazam, clonazepam, clorazepate, diazepam, flurazepam Opioids alfentanil, buprenorphine, butorphanol, codeine, dihydrocodeine, fentanyl, hydrocodone, hydromorphine, meperidine, methadone, morphine, nalbuphine, nucynta, oxycodone, oxymorphone, pentazocine, propoxyphene, remifentanil, sufentanil, tapentadol, talwin, tramadol, carfentanil, pethidine, and etorphine Antidepressants citalopram, escitalopram, fluoxetine, fluvozamine, paroxetine, sertraline; desvenlafaxine, duloxetine, levomilnacipran, milnacipran, venlafaxine; vilazodone, vortioxetine; nefazodone, trazodone; atomoxetine, reboxetine, teniloxazine, viloxazine; bupropion; amitriptyline, amitriptylinoxide, clomipramine, desipramine, dibenzepin, dimetacrine, dosulepin, doxepin, imipramine, lofepramine, melitracen,
    [Show full text]
  • Resume of Scientific Contributions to Psychopharmacology And
    RESUME OF SCIENTIFIC CONTRIBUTIONS TO PSYCHOPHARMACOLOGY AND BIOLOGICAL PSYCHIATRY While Fridolin Sulser was a visiting scientist from Switzerland in the Laboratory of Chemical Pharmacology at the National Institutes of Health in Bethesda, Maryland, he and B.B. Brodie utilized the reserpine-like syndrome as a "model depression" and in due course discovered the secondary amine desmethyl-imipramine (DM1) formed in vivo by oxidative N-demethylation of imipramine (1,2).DMI turned out to be the first selective inhibitor of the high affinity uptake of norepinephrine and triggered the development of many secondary amines of tricyclic antidepressants as therapeutic agents (e.g. desipramine, nortriptyline, protriptyline maprotiline, oxaprotiline, and more recently reboxetine). These drugs provided more selective pharmacologic tools to dissect the role of central noradrenergic mechanisms (3). During the early 1970s, Fridolin Sulser and his associates discovered that treatment with antidepressants on a clinically relevant time basis (including tricyclics, 4- Fridolin Sulser, M.D. Curriculum Vitae MAO inhibitors, some atypical antidepressants and electroconvulsive treatment) reduces selectively the responsiveness of the norepinephrine (NE) beta adrenoceptor coupled adenylate cyclase system in limbic and cortical structures of the rat brain (4,5). This deamplification of the central beta adrenoceptor system is often linked to a down- regulation of the Brnax value of beta adrenoceptors, without changes in the KD. These findings shifted the research emphasis on the mode of action of antidepressant treatments and on the pathophysiology of affective disorders from acute presynaptic to delayed post-synaptic receptor - second messenger mediated events and emphasized the role of adaptive processes at the level of signal transduction and opened the gateway for subsequent studies on changes of programs of gene expression.
    [Show full text]
  • Info on Skin Testing
    Information on Skin Testing *Please review 1 week prior to testing* Your Doctor has ordered an allergy test for you. Your appointment has been made for: ___________________________________ at _______________________AM/PM at our (date) (time) _ Foulkstone / Limestone / Glasgow _ office. Skin tests are a method of testing for allergic reactions to substances, or allergens, in the environment. Our practice utilizes a test that involves no needles! We use a prick method which involves a series of small plastic applicators that carry a specific antigen which is placed on your arms. The types of allergens we test for include weeds, trees, grasses, molds, animal dander, dust mites and some foods. The testing will take 45 minutes. Please remember to wear comfortable clothing with short sleeves. Reactions can consist of itchy eyes, nose or throat, nasal congestion, runny nose, tightness in the throat or chest, wheezing, lightheadedness, hives or anaphylactic shock. Although this is very rare, our staff is fully prepared with emergency equipment and a physician is always on site. To ensure accurate testing results, certain medicines should be stopped 5 days prior to testing, although you should not stop medicines without talking to your prescribing physician. Medications that interfere with testing include but are not limited to: Antihistamines are medicines used to treat allergies, nausea, and dizziness. Many are found in over the counter cold medicines. They include, but are not limited to: ALAVERT / CLARITIN (LORATIDINE) DRAMAMINE (DIMENHYDRINATE)
    [Show full text]
  • Xinyu Zhou, Bin Qin, Craig Whittington, 2 David Cohen, 3 Yiyun
    Open Access Protocol Comparative efficacy and tolerability of first-generation and newer-generation antidepressant medications for depressive disorders in children and adolescents: study protocol for a systematic review and network meta-analysis Xinyu Zhou,1 Bin Qin,1 Craig Whittington,2 David Cohen,3 Yiyun Liu,1 Cinzia Del Giovane,4 Kurt D Michael,5 Yuqing Zhang,1 Peng Xie1 To cite: Zhou X, Qin B, ABSTRACT et al Strengths and limitations of this study Whittington C, . Introduction: Depressive disorders are among the Comparative efficacy and most common psychiatric disorders in children and ▪ tolerability of first-generation This Bayesian network meta-analysis can inte- adolescents, and have adverse effects on their and newer-generation grate direct evidence with indirect evidence from antidepressant medications psychosocial functioning. Questions concerning the multiple treatment comparisons to estimate the for depressive disorders in efficacy and safety of antidepressant medications in the interrelations across all treatments. children and adolescents: treatment of depression in children and adolescents, ▪ We will comprehensively assess the efficacy, study protocol for led us to integrate the direct and indirect evidence tolerability, acceptability and suicide-related out- a systematic review and using network meta-analysis to create hierarchies of comes of first-generation and newer-generation BMJ network meta-analysis. these drugs. antidepressant medications for depression in Open 2015;5:e007768. Methods and analysis: Seven databases with children and adolescents. doi:10.1136/bmjopen-2015- PubMed, EMBASE, the Cochrane Library, Web of ▪ 007768 Several subgroup and sensitivity analyses will Science, CINAHL, LiLACS and PsycINFO will be address some clinically relevant questions. searched from 1966 to December 2013 (updated to ▪ This method comprehensively synthesises data ▸ Prepublication history for May, 2015).
    [Show full text]
  • Tricyclic Antidepressants Versus
    Jørgensen et al. Syst Rev (2021) 10:227 https://doi.org/10.1186/s13643-021-01789-0 PROTOCOL Open Access Tricyclic antidepressants versus ‘active placebo’, placebo or no intervention for adults with major depressive disorder: a protocol for a systematic review with meta-analysis and Trial Sequential Analysis Caroline Kamp Jørgensen1* , Sophie Juul1,2,3, Faiza Siddiqui1, Marija Barbateskovic1, Klaus Munkholm4, Michael Pascal Hengartner5, Irving Kirsch6, Christian Gluud1 and Janus Christian Jakobsen1,7 Abstract Background: Major depressive disorder is a common psychiatric disorder causing great burden on patients and societies. Tricyclic antidepressants are frequently used worldwide to treat patients with major depressive disorder. It has repeatedly been shown that tricyclic antidepressants reduce depressive symptoms with a statistically signifcant efect, but the efect is small and of questionable clinical importance. Moreover, the benefcial and harmful efects of all types of tricyclic antidepressants have not previously been systematically assessed. Therefore, we aim to investigate the benefcial and harmful efects of tricyclic antidepressants versus ‘active placebo’, placebo or no intervention for adults with major depressive disorder. Methods: This is a protocol for a systematic review with meta-analysis that will be reported as recommended by Pre- ferred Reporting Items for Systematic Reviews and Meta-Analysis Protocols, bias will be assessed with the Cochrane Risk of Bias tool—version 2, our eight-step procedure will be used to assess if the thresholds for clinical signifcance are crossed, Trial Sequential Analysis will be conducted to control random errors and the certainty of the evidence will be assessed with the Grading of Recommendations Assessment, Development and Evaluation approach.
    [Show full text]
  • A Database of Randomised Controlled Trials
    Zhang et al. BMC Psychiatry (2018) 18:162 https://doi.org/10.1186/s12888-018-1749-0 DATABASE Open Access Antidepressants for depressive disorder in children and adolescents: a database of randomised controlled trials Yuqing Zhang1,2†, Xinyu Zhou3†, Juncai Pu4, Hanping Zhang4, Lining Yang4, Lanxiang Liu4, Chanjuan Zhou1,2, Shuai Yuan4, Xiaofeng Jiang4 and Peng Xie1,2,4* Abstract Background: In recent years, whether, when and how to use antidepressants to treat depressive disorder in children and adolescents has been hotly debated. Relevant evidence on this topic has increased rapidly. In this paper, we present the construction and content of a database of randomised controlled trials of antidepressants to treat depressive disorder in children and adolescents. This database can be freely accessed via our website and will be regularly updated. Description: Major bibliographic databases (PubMed, the Cochrane Library, Web of Science, Embase, CINAHL, PsycINFO and LiLACS), international trial registers and regulatory agencies’ websites were systematically searched for published and unpublished studies up to April 30, 2017. We included randomised controlled trials in which the efficacy or tolerability of any oral antidepressant was compared with that of a control group or any other treatment. In total, 7377 citations from bibliographical databases and 3289 from international trial registers and regulatory agencies’ websites were identified. Of these, 53 trials were eligible for inclusion in the final database. Selected data were extracted from each study, including characteristics of the participants (the study population, setting, diagnostic criteria, type of depression, age, sex, and comorbidity), characteristics of the treatment conditions (the treatment conditions, general information, and detail of pharmacotherapy and psychotherapy) and study characteristics (the sponsor, country, number of sites, blinding method, sample size, treatment duration, depression scales, other scales, and primary outcome measure used, and side-effect monitoring method).
    [Show full text]
  • Comparative Efficacy and Acceptability of Interventions for Major Depression in Older Persons: Protocol for Bayesian Network Meta-Analysis
    Open Access Protocol BMJ Open: first published as 10.1136/bmjopen-2017-019819 on 21 January 2018. Downloaded from Comparative efficacy and acceptability of interventions for major depression in older persons: protocol for Bayesian network meta-analysis Tau Ming Liew,1,2,3 Cia Sin Lee4 To cite: Liew TM, Lee CS. ABSTRACT Strengths and limitations of this study Comparative efficacy and Introduction Major depression is a leading cause of acceptability of interventions disability and has been associated with adverse effects ► This systematic review and meta-analysis will for major depression in in older persons. While many pharmacological and non- older persons: protocol provide a comprehensive summary on the efficacy pharmacological interventions have been shown to be for Bayesian network and acceptability of all available interventions for effective to address major depression in older persons, meta-analysis. BMJ Open major depression in older persons. there has not been a meta-analysis that consolidates all the 2018;8:e019819. doi:10.1136/ ► The results will provide the highest level of evidence available interventions and compare the relative benefits bmjopen-2017-019819 to inform clinicians on the best choice of treatment of these available interventions. In this study, we aim to ► Prepublication history for from among the many available pharmacological conduct a systematic review and network meta-analysis this paper is available online. and non-pharmacological interventions. to compare the efficacy and acceptability of all the known To view these files, please visit ► This protocol has been developed in accordance pharmacological and non-pharmacological interventions for the journal online (http:// dx. doi.
    [Show full text]