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Newer antidepressants are as effective as older tricyclic agents in primary care patients

Three out of four adults suffering from depression seek help from their primary care physician. For these patients, the newer antidepressants relieve depression as effectively as the older tricyclic agents and may cause fewer side effects, concludes a review of 28 trials involving nearly 6,000 adult primary care patients. The review was conducted by researchers at the Evidence-based Practice Center at the University of Texas Health Sciences Center, which is one of 12 such centers supported by the Agency for Healthcare Research and Quality (Contract no. 290-97-0012).

Cynthia D. Mulrow, M.D., M.Sc., and colleagues reviewed the literature comparing new drugs such as selective serotonin reuptake inhibitors, serotonin norepinephrine inhibitors, reversible inhibitors of monoamine oxidase, and dopamine antagonists, with either placebo or tricyclic agents. They found that on average 63 percent of adults taking newer agents and 60 percent of adults taking tricyclics found significant relief from depression (at least a 50 percent improvement in symptoms as measured by a depressive symptoms rating scale). Only 35 percent of adults taking a placebo found such relief.

Eight percent of adults taking new agents and 13 percent of those taking tricyclics dropped out of treatment because of adverse effects such as headache, nausea, constipation, and dizziness. These adults suffered from either major depression, depression requiring treatment as judged by the primary care physician, dysthymia (mild, lingering depression), mixed anxiety depression, or more than one type of depressive disorder. Except for one study, patients were not alcoholics and did not have serious medical illnesses or cognitive impairment.

This review highlights major gaps in the evidence concerning the optimal treatment of depression in primary care settings, according to the authors. Trials of new medications have been limited in scope and have not addressed the benefits, risks, and costs of alternative psychosocial and herbal treatments. The authors call for effectiveness studies conducted in broader groups of primary care patients with less severe depression and greater medical and psychiatric problems instead of more studies of similar antidepressants.

For more information, see "Efficacy of newer medications for treating depression in primary care patients," by Dr. Mulrow, John W. Williams, Jr., M.D., M.H.S., Elaine Chiquette, Pharm.D., and others, in the January 2000 American Journal of Medicine 108, pp. 54-64.

Editor's Note: Evidence Report No. 7, Treatment of Depression—Newer Pharmacotherapies (AHRQ Publication No. 99-E014), is available online. Print copies of this AHRQ-supported report are available from the AHRQ Clearinghouse; copies of the report summary (AHRQ Publication No. 99-E013) are also available from the Clearinghouse.

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