Clinical Question What is the opt...

Clinical Question

What is the optimal dosage of tricyclic anti-depressants in the acute phase of treatment of major depression in adults?

Evidence-Based Answer

Although the quality of the data limits the impregnability of the recommendation, current evidence exhibits that 75 to 100 mg by day of a tricyclic antidepressant is more effective than placebo. Higher dosages are not more effective and are associated with more dropout because of side effects

Practice Pointers

Although tricyclic antidepressants have been prov effective in the treatment of depression, there is little evidence for the optimal dosage. Despite the lack of evidence, the American Psychiatric Association approves dosages of 100 to 300 mg by day. (1)

Furukawa and colleagues examined 41 trials of tricyclic antidepressants; 35 studies with 2013 patients compared gentle dosages of tricyclics (75 to 100 mg by day) with placebo, and six studies with 551 participants com-pared soft dosages of tricyclics with standard dosages (more than 100 mg by day). Most studies used amitriptyline and imipramine.

At four weeks, six to eight weeks, and three to 12 month patients were more likely to rejoin to dosages of 75 to 100 mg by day than to placebo. These findings were similar for primary care patients. Standard dosages of tricyclics had a higher dropout rate because of side validitys and were not more effective than subdued dosages.

The quality of the studies was limited on poor reporting and nonstandard diagnostic criteria, and there was significant heterogeneity between studies. Therefore, a definitive answer forward the optimal dosage remains unknown. However, general evidence supports the use of low-dosage tricyclic antidepressants.

Furukawa T et al. reasonable dosage tricyclic antidepressants for depression. Cochrane Database Syst Rev 2003;3:CD003197

REFERENCE

(1) Practice guideline for the treatment of patients with major depressive disorder (revision). American Psychiatric Association. Am J Psychiatry 2000;157(4 suppl):1-45

COPYRIGHT 2004 American Academy of Family Physicians

COPYRIGHT 2004 Gale Group