A double-blind comparative study of sertraline and amitriptyline in outpatients with major depressive episodes

BackgroundThere is growing interest in glutamatergic agents in depression, particularly ketamine, a glutamate N-methyl-d-aspartate (NMDA) receptor antagonist. We aimed to assess the efficacy of ketamine in major depressive episodes.MethodWe searched EMBASE, PsycINFO, CENTRAL, and Medline from 1962 to January 2014 to identify double-blind, randomized controlled trials with allocation concealment evaluating ketamine in major depressive episodes. Clinical remission, response and depressive symptoms were extracted by two independent raters. The primary outcome measure was clinical remission at 24 h, 3 days and 7 days post-treatment. Analyses employed a random-effects model.ResultsData were synthesized from seven RCTs employing an intravenous infusion and one RCT employing intranasal ketamine, representing 73 subjects in parallel arms and 110 subjects in cross-over designs [n = 34 with bipolar disorder (BD), n = 149 with major depressive disorder (MDD)]. Ketamine was associated with higher rates of clinical remission relative to comparator (saline or midazolam) at 24 h [OR 7.06, number needed to treat (NNT) = 5], 3 days (OR 3.86, NNT = 6), and 7 days (OR 4.00, NNT = 6), as well as higher rates of clinical response at 24 h (OR 9.10, NNT = 3), 3 days (OR 6.77, NNT = 3), and 7 days (OR 4.87, NNT = 4). A standardized mean difference of 0.90 in favor of ketamine was observed at 24 h based on depression rating scale scores, with group comparisons revealing greater efficacy in unipolar depression compared to bipolar depression (1.07 v. 0.68). Ketamine was associated with transient psychotomimetic effects, but no persistent psychosis or affective switches.ConclusionOur meta-analysis suggests that single administrations ketamine are efficacious in the rapid treatment of unipolar and bipolar depression. Additional research is required to determine optimal dosing schedules, route, treatment schedules, and the potential efficacy of other glutamatergic agents.

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A Double-Blind Comparative Multicentre Study of Paroxetine and Placebo in Preventing Recurrent Major Depressive Episodes

Journal of Psychopharmacology ◽

10.1177/026988119200600164 ◽

1992 ◽

Vol 6 (1) ◽

pp. 121-121

Keyword(s):

Multicentre Study ◽

Major Depressive ◽

Double Blind ◽

Major Depressive Episodes ◽

Depressive Episodes

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A Double-blind Comparative Trial of Moclobemide v. Imipramine and Placebo in Major Depressive Episodes

The British Journal of Psychiatry ◽

10.1192/s0007125000297523 ◽

1989 ◽

Vol 155 (S6) ◽

pp. 72-77 ◽

Cited By ~ 57

Author(s):

M. Versiani ◽

U. Oggero ◽

P. Alterwain ◽

R. Capponi ◽

F. Dajas ◽

...

Keyword(s):

Rating Scale ◽

Comparative Trial ◽

Placebo Treatment ◽

Major Depressive ◽

Double Blind ◽

Poor Tolerance ◽

The Mean ◽

Major Depressive Episodes ◽

Depressive Episodes ◽

Important Drug

Patients (n = 490) suffering from a major depressive episode according to DSM-III criteria were randomly allocated to groups receiving either moclobemide, imipramine, or placebo treatment. Subjects were treated as out-patients for 6 weeks. On overall assessment of efficacy and on results of the Hamilton Rating Scale for Depression, both moclobemide and imipramine were superior to placebo, but the differences between moclobemide and imipramine were not significant. Premature termination due to insufficient efficacy was more frequent with placebo than with moclobemide or with imipramine, these differences being significant. The overall assessment of tolerance clearly favoured placebo and moclobemide over imipramine. This was also reflected in the frequency of premature terminations due to poor tolerance, as well as in the frequency of adverse events, which were highest in the imipramine group. The only cardiovascular finding was an increase of the mean heart rate with imipramine, maximum at the end of week 1, while placebo and moclobemide displayed no relevant changes. There were no other important drug-related changes.

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Adjunctive Armodafinil for Major Depressive Episodes Associated With Bipolar I Disorder: A Randomized, Multicenter, Double-Blind, Placebo-Controlled, Proof-of-Concept Study

Yearbook of Psychiatry and Applied Mental Health ◽

10.1016/j.ypsy.2011.07.045 ◽

2012 ◽

Vol 2012 ◽

pp. 295-296

Author(s):

J.C. Ballenger

Keyword(s):

Proof Of Concept ◽

Major Depressive ◽

Double Blind ◽

Bipolar I Disorder ◽

Double Blind Placebo ◽

Concept Study ◽

Major Depressive Episodes ◽

Depressive Episodes

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Clinical implications of directly switching antidepressants in well-treated depressed patients with treatment-emergent sexual dysfunction: a comparison between vortioxetine and escitalopram

CNS Spectrums ◽

10.1017/s1092852919000750 ◽

2019 ◽

Vol 25 (1) ◽

pp. 50-63 ◽

Cited By ~ 3

Author(s):

Paula L. Jacobsen ◽

George G. Nomikos ◽

Wei Zhong ◽

Andrew J. Cutler ◽

John Affinito ◽

...

Keyword(s):

Sexual Dysfunction ◽

Sexual Functioning ◽

Rating Scale ◽

Primary Study ◽

Major Depressive ◽

Double Blind ◽

Scale Scores ◽

Major Depressive Episodes ◽

Depressive Episodes ◽

Ssri Treatment

Objective:The objective of this work was to describe treatment-emergent sexual dysfunction (TESD) and tolerability following a switch from selective serotonin reuptake inhibitor (SSRI: citalopram, paroxetine, or sertraline) monotherapy to vortioxetine or escitalopram monotherapy in adults with well-treated major depressive disorder (MDD) and SSRI-induced sexual dysfunction.Methods:Data were analyzed from the primary study, an 8-week, randomized, double-blind, head-to-head study in which participants with well-treated depressive symptoms but experiencing TESD with SSRIs were directly switched to flexible doses (10/20 mg) of vortioxetine or escitalopram. Sexual functioning was assessed by the Changes in Sexual Functioning Questionnaire-14 (CSFQ-14), efficacy by the Montgomery–Åsberg Depression Rating Scale scores (MADRS) and Clinicians Global Impression of Severity/Improvement (CGI-S/CGI-I), and tolerability by adverse events. Efficacy and tolerability were assessed by pre-switch SSRI therapy where possible, and by participant characteristics.Results:Greater improvements in TESD were seen in the vortioxetine compared with escitalopram groups based on: participant demographics (≤45 years, women; P = 0.045), prior SSRI treatment (P = 0.044), number of prior major depressive episodes (MDEs) (1–3; P = 0.001), and duration of prior SSRI therapy (>1 year; P = 0.001). Prior SSRI treatment did not appear to influence the incidence or severity of TEAEs, except for nausea. Regardless of prior SSRI, both treatments maintained antidepressant efficacy after 8 weeks.Conclusion:Results suggest that vortioxetine is a safe and effective switch therapy for treating SSRI-induced sexual dysfunction in adults with well-treated MDD. Also, improvement in sexual dysfunction with vortioxetine or escitalopram may be influenced by prior SSRI usage, sex, age, and history of MDEs.

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