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DIFFERENCES BETWEEN SECOND-GENERATION ANTIDEPRESSANTS?
Submit responseBased on published studies, Hansen and colleagues (1) recently stated that second–generation antidepressants do not differ from one another in the treatment of major depression. We believe, however, that in terms of both efficacy and side effects, there are indeed significant differences, and that these differences could be seen if greater consideration could be given to the following points: populations studied, length of the studies and drug dosages.
Regarding the populations studied, Hansen considered only primary care patients. Many studies have shown that antidepressant efficacy is more pronounced in those studies which included in-patients with severe depression (2).
On the question of the length of the studies, Hansen took into consideration only those studies which lasted three months or longer. But in some short-term studies, for example 4 to 8 weeks, differences between the antidepressants were found (2,3,4).
We would also like to point out that the published studies examined did not give sufficient attention to the extent to which the antidepressant dosage can affect efficacy and side effects. Only 7 of the 50 studies reviewed by Hansen (14%) are fixed-dose studies; the remaining are flexible-dose studies, which are less informative for drug comparisons. Differences were observable among fixed-dose studies of second-generation drugs (2,3,5).
In conclusion, in the interest of providing the best possible treatment for those suffering from major depression, we argue for better knowledge of differences between antidepressants. As pharmaceutical companies have up until now only provided inconclusive data in this area, we recommend that future studies comparing various antidepressants be sponsored by public health research funds.
References 1. Hansen RA, Gartlehner G, Lohr KN , Gaynes BN, Carey TS. Efficacy and safety of second-generation antidepressants in the treatment of major depressive disorder. Ann Intern Med. 2005;143:415-26.
2. Khan A, Kolts RL, Thase ME, Krishnan KRG, Brown WA. Research Design features and patient characteristics associated with the outcome of antidepressant clinical trials. Am J Psychiatry. 2004;161:2045-49.
3. Thase ME, Entsuah AR, Rudolph RL. Remission rates during treatment with venlafaxine or selective serotonin reuptake inhibitors. Br J Psychiatry. 2001;178:234-41.
4. Moore N, Verdoux H, Fantino B. Prospective, multicentre, randomized, double-blind study of the efficacy of escitalopram versus citalopram in outpatient treatment of major depressive disorder. Int Clin Psychopharmacol. 2005;20:131-7. 5. Corruble E, Guelfi JD Antidepressants and major depression: relationship between efficacy and dosage in the therapeutic range ? Acta Psychiatr Scand. 2000;101:343-8.
Conflict of Interest:
None declared
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Newer Antidepressants and Risk of Bleeding
Submit responseDear Editor,
In the treatment of major depression,newer antidepressants are very effective and improve quality of life in these patients.These drugs act primarily by inhibiting serotonin reuptake and recently an increase in incidence gastointestinal bleeding and bleeding from other sites have been reported in patients taking these agents.This could be due to inhibition of platelet activation by serotonin.Risk of bleeding is further increased if patient is already on antiplatelet drugs.Although none of the patients in this study had bleeding as an adverse effect,care should be taken regarding history of bleeding disorder and use of antiplatelet drugs before prescribing newer antidepressants.
Conflict of Interest:
None declared