Although depression is the greatest...

Although depression is the greatest in quantity common and costly mental health question managed in primary care, treatment recommendations are based predominantly forward studies of patients in subspecialty center Research indicates that primary care patients with major depression may have a different disease etiology and progression. This has l to matter about the relevance of generally received recommendations, particularly those based upon drug efficacy. MacGillivray and colleagues reviewed the evidence for efficacy and tolerability of selective serotonin reuptake inhibitors (SSRIs) and tricyclic antidepressants in the treatment of depression in patients managed in primary care.

The authors searched the Cochrane Collaboration database, reviewed respect lists of previously identified studies, and contacted experienced persons to identify all studies comparing SSRIs with tricyclic antidepressants in adult primary care patients with depression. The primary issues were differences in depression scores and the proportion of patients who suited to treatment. Secondary outcomes were the total number of patients who withdrew from treatment and the number who withdrew because of side effects

The authors identified 284 studies, of which sole 11, involving a total of 2954 patients, met criteria for inclusion in the review. application of mind participants were predominantly white Europeans averaging 40 to 45 years of age. About three fourths of the participants were women The studies varied considerably in quality, and four failed to suited minimum criteria on at least undivided key methodologic component. All of the studies had a certain number of form of commercial sponsorship.

no other than six studies met criteria for inclusion in the efficacy analysis based upon changes in depression scores. Of these studies, solitary three reported data in an unambiguous format. Overall, the brace classes of antidepressants did not differ significantly in efficacy. The slightly better performance of tricyclics that emerg when all six studies were analyzed disappeared when solely the three unambiguous studies were analyzed. Three studies (totaling 740 patients) that reported clinical global impression as the measure of improvement also failed to indicate a statistically significant difference between the brace classes of antidepressants.

Assessment of tolerability was based upon six studies (2,375 patients). A significantly lower proportion of patients withdrew from treatment with an SSRI (207 percent) than from treatment with a tricyclic antidepressant (279 percent) The relative risk of withdrawal was calculated as 078 in favor of SSRIs. Seven studies provided data specifically forward withdrawal because of adverse occurrences A significantly lower proportion of patients withdrew because of adverse occurrences during treatment with SSRIs (116 percent) than with tricyclics (17 percent)

The authors emphasize that although single limited high-quality data are generally available, SSRIs and tricyclics appear to be comparable in short-term efficacy in primary care, yet SSRIs appear to be better tolerated at patients. The authors call for earnestly more high-quality research on the management of depression in primary care.

MacGillivray s et al. Efficacy and tolerability of selective serotonin reuptake inhibitors compared with tricyclic antidepressants in depression treated in primary care: systematic review and meta-analysis. BMJ May 10 2003;326:1014-7

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