scholarly journals Cost-effectiveness and cost-utility of tricyclic antidepressants, selective serotonin reuptake inhibitors and lofepramine

2006 ◽  
Vol 188 (4) ◽  
pp. 337-345 ◽  
Author(s):  
Tony Kendrick ◽  
Robert Peveler ◽  
Louise Longworth ◽  
David Baldwin ◽  
Michael Moore ◽  
...  
Keyword(s):  
Primary Care ◽  
Cost Effectiveness ◽  
Serotonin Reuptake ◽  
Selective Serotonin Reuptake Inhibitors ◽  
Tricyclic Antidepressants ◽  
Randomised Trial ◽  
Depression Scale ◽  
Serotonin Reuptake Inhibitors ◽  
Selective Serotonin ◽  
First Choice

BackgroundThe cost-effectiveness of tricyclic antidepressants (TCAs) and selective serotonin reuptake inhibitors (SSRIs) has not been compared in a prospective study in primary care.AimsTo determine the relative cost-effectiveness of TCAs, SSRIs and lofepramine in UK primary care.MethodAn open-label, three-arm randomised trial with a preference arm. Practitioners referred 327 patients with incident depression.ResultsNo significant differences were found in effectiveness or cost-effectiveness. The numbers of depression-free weeks over 12 months (on the Hospital Anxiety and Depression Scale) were 25.3 (95% CI 21.3–29.0) for TCAs, 28.3 (95% CI 24.3–32.2) for SSRIs and 24.6 (95% CI 20.6–28.9) for lofepramine. Mean health service costs per patient were $762 (95% CI 553–1059) for TCAs, $875 (95% CI 675–1355) for SSRIs and $867 (95% CI 634–1521) for lofepramine. Cost-effectiveness acceptability curves suggested SSRIs were most cost-effective (with a probability of up to 0.6).ConclusionsThe findings support a policy of recommending SSRIs as first-choice antidepressants in primary care.

Clinical comparison of selective serotonin reuptake inhibitors in the treatment of geriatric depression: a review of literature

2000 ◽  
Vol 10 (4) ◽  
pp. 349-373 ◽  
Author(s):  
Richard Marc Patel
Keyword(s):  
Side Effect ◽  
Serotonin Reuptake ◽  
Selective Serotonin Reuptake Inhibitors ◽  
Relevant Literature ◽  
The Elderly ◽  
The United States ◽  
Serotonin Reuptake Inhibitors ◽  
Selective Serotonin ◽  
Geriatric Depression ◽  
First Choice

IntroductionWith their ease of administration, relatively benign side-effect profile and safety in overdose, in the United States the selective serotonin reuptake inhibitors (SSRIs) have become de facto first choice in the treatment of geriatric depression, displacing tricyclic antidepressants (TCAs). In this paper, the relevant literature regarding neurochemistry, kinetics, dosing, efficacy and differential side-effect profiles of citalopram, fluvoxamine, fluoxetine, sertraline, and paroxetine, the five currently available SSRIs in the USA, will be reviewed with special emphasis on geriatric data. Of late, considerable controversy has been generated regarding whether SSRIs are as effective as TCAs in severe and melancholic depressive subtypes. This important issue will be explored and the relative utility of all the SSRIs in the elderly patient compared and contrasted. Finally, reasons for difficulties in comparing results across studies will be elucidated.

Abstract WP167: Effects of Selective Serotonin Reuptake Inhibitors versus Tricyclic Antidepressants on Cerebrovascular Events

Stroke ◽  
2013 ◽  
Vol 44 (suppl_1) ◽  
Author(s):  
Jou Wei Lin ◽  
Chia-Hsuin Chang ◽  
Chin-Hsien Lin
Keyword(s):  
Confidence Interval ◽  
Serotonin Reuptake ◽  
Selective Serotonin Reuptake Inhibitors ◽  
Tricyclic Antidepressants ◽  
Hazard Ratio ◽  
Serotonin Reuptake Inhibitors ◽  
Adjusted Hazard Ratio ◽  
Selective Serotonin ◽  
Cerebrovascular Events ◽  
Reduced Risk

Background: The objective of this study was to examine the effects of selective serotonin reuptake inhibitors (SSRIs) versus tricyclic antidepressants (TCAs) on cerebrovascular events in patients with depression or anxiety. Methods: We performed a retrospective cohort study in a nationwide population. The patients who started to take SSRIs and TCAs with a diagnosis of depression or anxiety between January 1, 2001 and December 31, 2009 were identified from the Taiwan National Health Insurance claims database. We examined the association between the two types of antidepressants and incidence of stroke using a proportional hazard model adjusted for risk factors for stroke. Results: Among of the 24,662 SSRI and 14,736 TCA initiators, the crude incidence rate for stroke was 10.03 and 13.77 per 100 person-years respectively. SSRI use was associated with a significantly reduced risk as compared with TCAs with the adjusted hazard ratio of 0.67 (95% confidence interval 0.47 to 0.96) in a dose-dependent manner. No significant effect modification was found among subgroups, such as hypertension, diabetes, previous cardiovascular and cerebrovascular diseases. The adjusted hazard ratio was 1.09 (95% confidence interval 0.65 to 1.85) for those aged more than 65 years, suggesting only a potential trend for a higher risk of stroke with SSRIs in the geriatric group. Conclusions: As compared with TCAs, the use of SSRIs was associated with a reduced risk for cerebrovascular events in a clear dose-response manner. Further researches are needed to examine the potential risk and benefit of SSRI use for patients with high risk of stroke.

Sign in / Sign up

Export Citation Format

Share Document