Are Antidepressants All the Same? Surveying the Opinions of Australian Psychiatrists

Objective: Controlled trials do not suggest differences in efficacy between antidepressant compounds. Psychiatrists, however, frequently express the view that real differences do exist and are relevant to clinical practice. Since multiple comparative trials are not feasible, an alternative method for expanding the evidence base is to survey regularly the opinions of practising psychiatrists. Method: Two surveys of psychiatrists' opinions were conducted. Participants in the first survey were drawn from contact with ‘SPHERE: A National Depression Project’, while those in the second survey responded to a brief questionnaire distributed with Australasian Psychiatry. Results: Reported volumes of scripts written, ratings of efficacy and tolerability, and preferences in specific clinical situations indicate that clinical psychiatrists now strongly prefer the newer antidepressant agents. They rate serotonin and noradren-alin re-uptake inhibitors (SNRIs) and selective serotonin re-uptake inhibitors (SSRIs) highest for antidepressant efficacy, serotonin receptor subtype 2 (5HT2) antagonists and some SSRIs highest for anti-anxiety efficacy, and some SSRIs and reversible inhibitors of monoamine oxidase inhibitor-A (RIMAs) lowest for side-effect burden. Further, SSRIs were their first preferences for most clinical situations. Serotonin and noradrenalin re-uptake inhibitors were the preferred choice for treatment-resistant depression and patients who had failed to respond to one SSRI. Serotonin receptor subtype 2 antagonists were the second choice to SSRIs for mixed anxiety and depression, and major depression with sleep disturbance. Reversible inhibitors of monoamine oxidase inhibitor-A were the second choice to SSRIs for adolescents with major depression, patients aged over 65 years, patients with serious medical illnesses and patients with chronic fatigue. Tricyclic antidepressants (TCAs) were the preferred choice for patients with chronic pain, and second choice to SSRIs for patients with major depression with panic disorder, postnatal disorders and patients with psychotic depression. Conclusion: Psychiatrists believe that important differences do exist between available antidepressant compounds. Such opinions are divergent from limited controlled data but may be influenced by a wide range of factors other than direct clinical experience. The role of such surveys in ongoing evaluation of clinical practice is emphasised.

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The clinical relevance of treatment with antidepressants

Acta Neuropsychiatrica ◽

10.1017/s092427080003756x ◽

1995 ◽

Vol 7 (2) ◽

pp. 52-54 ◽

Cited By ~ 1

Author(s):

W.A. Nolen

Keyword(s):

Monoamine Oxidase ◽

Clinical Relevance ◽

Rating Scales ◽

Monoamine Oxidase Inhibitor ◽

Oxidase Inhibitor ◽

Tricyclic Antidepressant ◽

Statistical Evidence ◽

Monoamine Oxidase A ◽

Selective Serotonin ◽

Uptake Inhibitors

Oince the discovery in the late 1950's of imipramine (Tofranil®), the first tricyclic antidepressant (TCA), and iproniazid, the first monoamine oxidase inhibitor (MAOI), many other TCAs and MAOIs, now being considered the classical antidepressants, have become available. Their effectiveness has been shown in numerous studies, although according to nowadays standards well designed studies (placebo-controlled, defined diagnostic groups, the use of standardized rating scales) with these compounds are relatively scarce.From the early 1980's the so called modern antidepressants have been introduced: the selective serotonin re-uptake inhibitors (SSRIs), the reversible selective monoamine oxidase-A inhibitors (RIMAs) and a variety of other compounds. All these drugs have been registered after their effectiveness had been shown in well designed, placebo-controlled studies. In defining the efficacy of antidepressants, registration authorities consider two aspects important: statistical evidence and clinical relevance.

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An Australian Multicentre Study of Moclobemide versus Amitriptyline in the Treatment of Depression

Australian & New Zealand Journal of Psychiatry ◽

10.3109/00048679209072070 ◽

1992 ◽

Vol 26 (3) ◽

pp. 454-458 ◽

Cited By ~ 3

Author(s):

Larry Evans ◽

Tom George ◽

Brendan O'sullivan ◽

Philip Mitchell ◽

Gordon Johnson ◽

...

Keyword(s):

Major Depression ◽

Monoamine Oxidase ◽

Multicentre Study ◽

Monoamine Oxidase Inhibitor ◽

Oxidase Inhibitor ◽

Monoamine Oxidase A ◽

Double Blind ◽

Blood Pressure Elevation ◽

Treatment Of Depression ◽

Blind Comparison

This paper reports the results of a multicentre study of the new monoamine oxidase inhibitor, moclobemide, in the treatment of major depression. Moclobemide is a specific monoamine oxidase-A inhibitor which does not bind irreversibly to the enzyme, unlike the currently available MAOIs. Recent studies would suggest that in subjects taking moclobemide blood pressure elevation caused by tyramine is significantly less than that induced by the irreversible MAOIs, particularly when tyramine is administered in an oral form. Forty-eight patients with major depression were randomly allocated to treatment with either moclobemide or amitriptyline for 4 weeks in a double-blind comparison. There were no statistically significant differences between the two groups on measures of efficacy. Patients taking amitriptyline reported a greater number of side-effects and more patients in the amitriptyline group dropped out because of these. There were no reports of interactions with tyramine-containing foods.

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Possible antidepressant/mania-inducing effects of methionine: a reappraisal of the effects of methionine in chronic psychosis using modern diagnostic criteria

Psychiatry and Psychobiology ◽

10.1017/s0767399x00001619 ◽

1989 ◽

Vol 4 (3) ◽

pp. 175-181

Author(s):

J.F. Lipinski ◽

R.C. Alexander

Keyword(s):

Monoamine Oxidase ◽

Diagnostic Criteria ◽

Monoamine Oxidase Inhibitor ◽

Manic Episode ◽

Oxidase Inhibitor ◽

Descriptive Data ◽

Antidepressant Effects ◽

Chronic Psychosis

SummaryThe authors have reviewed 13 published studies on methionine administration, usually in combination with a monoamine oxidase inhibitor (MAOI), to chronically psychotic patients, using modern (DSM-III) diagnostic criteria. Four of these studies contained sufficient descriptive data to allow reappraisal of the effects. The results of the review suggest that a proportion of the patients experienced the induction of a manic episode/antidepressant effects rather than the reported worsening of schizophrenia while treated with a methionine-MAOI combination. It is suggested that these observations are consistent with recent findings that S-adenosyl-L-methionine (SAMe) has antidepressant and mania-inducing effects.

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