Effectiveness of antidepressants:
comparative remission rates

by
Thase ME.
University of Pittsburgh School of Medicine,
Western Psychiatric Institute and Clinic,
Pittsburgh, Pa.
J Clin Psychiatry 2003;64 Suppl 2:3-7


ABSTRACT

Historically, clinical researchers have gauged the short-term effectiveness of antidepressants by response rates, which have been defined as a "significant" reduction of symptoms or a global impression of at least moderate benefit. However, increased focus over the past decade has led many researchers to suggest that remission, i.e., a virtual elimination of depressive symptoms and restoration of psychosocial functioning, should be the primary goal of the initial phase of therapy. This article examines the relative efficacy of various antidepressant therapies. There is some evidence that medications affecting multiple neurochemical systems, such as the tricyclics amitriptyline and clomipramine (in studies of hospitalized patients) and the more selective "dual reuptake inhibitor" venlafaxine, may result in higher rates of remission relative to other agents. Given the better tolerability of newer antidepressants relative to tricyclics, both logic and an increasing amount of data support a greater role for multiaction antidepressants.
TCAs
SSRIs
RIMAs
Options
Bupropion
Amineptine
Reboxetine
Nefazodone
Mirtazapine
Venlafaxine
21st Century
When SSRIs fail
Antidepressants
Tranylcypromine
Atypical depression
Retarded depression
The monoamine hypothesis
Old and new antidepressants
Mood-brighteners and antidepressants
Types of depression and mood-disorder
Antidepressant augmentation strategies
Antidepressants: tolerability and adherence
Montgomery-Asberg v Hamilton depression rating scales
Depression and antidepressants: remission, dropouts, and ADRs
The placebo vs nocebo effect: opioid and dopaminergic substrates
Selective publication of clinical trials leads to unrealistic estimates of antidepressant efficacy


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