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#Post#: 6--------------------------------------------------
Newer Class Of Antidepressants Similar In Effectiveness, Side
Effects Differ
DIR By: Bipolar Girl
Date: August 30, 2010, 4:26 pm
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Jan 29, 2007
Today's most commonly prescribed antidepressants are similar in
effectiveness to each other but differ when it comes to possible
side effects, according to an analysis released today by HHS'
Agency for Healthcare Research and Quality.
The findings, based on a review of nearly 300 published studies
of second-generation antidepressants, show that about six in 10
adult
patients get some relief from the drugs. About six in 10 also
experience at least one side effect, ranging from nausea to
sexual dysfunction.
Patients who don't respond to one of the drugs often try another
medication within the same class. About one in four of those
patients recover, according to the review. Overall, current
evidence on the drugs is insufficient for clinicians to predict
which medications will work best for individual patients.
Second-generation antidepressants, which include selective
serotonin reuptake inhibitors (SSRIs) and serotonin and
norepinephrine reuptake inhibitors (SNRIs), are often prescribed
because first-generation antidepressants (such as tricyclic
antidepressants, or TCAs) can cause intolerable side effects and
carry high risks.
"Second-generation antidepressants provide hope for many of the
millions of Americans who struggle with depression," said AHRQ
Director Carolyn M. Clancy, MD. "But often trying to find the
right drug is trial and error, and in many cases relief is
temporary or comes with serious side effects. It's clear we need
more evidence to help patients and their doctors make the best
choices."
Authors of the new Comparative Effectiveness Review analyzed the
benefits and risks of a dozen second-generation antidepressants:
bupropion (sold as Wellbutrin), citalopram (Celexa), duloxetine
(Cymbalta), escitalopram (Lexapro), fluoxetine (Prozac),
fluvoxamine (formerly sold as Luvox), mirtazapine (Remeron),
nefazodone (formerly Serzone), paroxetine (Paxil), sertraline
(Zoloft), trazodone (formerly Desyrel), and venlafaxine
(Effexor). Many of these drugs are also sold in generic form.
The analysis, which examined only adult use of second-generation
antidepressants, drew on 293 published studies. Of those, 187
were judged to be of good or fair quality. The analysis compared
the drugs' benefits and risks in the treatment of major
depressive disorder, dysthymia (a chronic, less-severe form of
depression), and subsyndromal depression (an acute mood disorder
that is less severe than major depression).
Each of the disorders can be disabling. Major depressive
disorder affects more than 16 percent of U.S. adults at least
once during a lifetime, the review noted. In 2000, the economic
burden of depressive disorders was estimated to be $83.1
billion. More than 30 percent of these costs are for direct
medical expenses, such as doctors' fees, hospital bills and
medications.
The new analysis, produced by AHRQ's Effective Health Care
program, was completed by the Agency's RTI
International-University of North Carolina Evidence-based
Practice Center. Evidence reviewed by the authors suggests:
In general, the various second-generation antidepressants have
similar rates of effectiveness. In controlled studies, about 38
percent of patients saw no improvement and 54 percent had only
partial improvement.
According to the National Institute of Mental Health's Sequenced
Treatment Alternative to Relieve Depression (STAR-D) trial, a
substantial number (between about 25 percent and 33 percent) of
patients will improve with the addition or substitution of a
different drug.
On average, 61 percent of patients taking second-generation
antidepressants experience at least one side effect. The most
common are nausea and vomiting, constipation, diarrhea,
dizziness, headache, and sleeplessness.
Venlafaxine, an SNRI, is associated with a higher incidence of
nausea and vomiting than SSRIs. That drug is also more likely
than SSRIs to be discontinued due to adverse events.
Sertraline is more likely to cause diarrhea than bupropion,
citalopram, fluoxetine, fluvoxamine, mirtazapine, nefazodone,
paroxetine, or venlafaxine. Mirtazapine leads to higher weight
gains than fluoxetine, paroxetine, venlafaxine, or trazodone.
Trazodone is associated with higher rates of sleeplessness than
bupropion, fluoxetine, mirtazapine, paroxetine, or venlafaxine.
Paroxetine and venlafaxine have the highest rates of
discontinuation. Fluoxetine has the lowest.
Second-generation antidepressants work at different rates. Seven
studies funded by the maker of mirtazapine showed that the drug
works faster than citalopram, fluoxetine, paroxetine, or
sertraline.
Bupropion is less likely to cause sexual dysfunction than
fluoxetine, paroxetine, or sertaline. Paroxetine has higher
rates of sexual dysfunction than fluoxetine, fluvoxamine,
nefazodone, or sertraline.
"As with all medications, second-generation antidepressants
should be used after careful consideration of benefits and
risks,'' Dr. Clancy said. "It's up to clinicians and patients to
work closely together so the best possible results are
achieved."
The report released today, Comparative Effectiveness of
Second-Generation Antidepressants in the Pharmacologic Treatment
of Adult Depression, is the newest analysis from AHRQ's
Effective Health Care program. That program represents an
important federal effort to compare alternative treatments for
significant health conditions and make the findings public. The
program is intended to help patients, doctors, nurses, and
others choose the most effective treatments. Information on the
program, including full reports, can be found at
HTML http://effectivehealthcare.ahrq.gov
.
Agency for Healthcare Research and Quality (AHRQ)
540 Gaither Rd.
Rockville, MD 20850
United States
HTML http://www.ahrq.gov/
#Post#: 14--------------------------------------------------
Re: Newer Class Of Antidepressants Similar In Effectiveness,
Side Effects Differ
DIR By: Bighpolarbear
Date: August 31, 2010, 1:22 pm
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Interesting. I am currently taking sertraline (Zoloft). To be
honest I am on a low does which is monitored, I was on 200mg and
it sent me Manic and took a long time to reach earth once it was
lowered... However i have not experienced any negative effect
like i did with Prozac. :o
#Post#: 16--------------------------------------------------
Re: Newer Class Of Antidepressants Similar In Effectiveness,
Side Effects Differ
DIR By: Bipolar Girl
Date: August 31, 2010, 1:52 pm
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I tried Zoloft 2x. Each time it just stopped working for me like
the gas ran out of a car. It was the strangest thing. It just
came to a screeching halt. I had nothing from it. Not even
fumes.
Zoloft is very controversial in the US. Some studies came out
that said it does nothing. That is right. The studies said it is
nothing but a sugar pill. Doctors moved away from it. Patients
have decided they don't want it. It is a pill without a home in
the US.
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