Table 1. Properties of studies included for analysis.
Antidepressant (including dose range, duration, adherence) | Authors | Psychiatric diagnoses and comorbidities (including method of identification) | Medical comorbidities and concurrent treatments (including method of identification) | Outcome Measures (including times of measurement) | Number of Subjects (including at commencement, completion, and analysis) | Results of Outcome Measures (including relevant confidence intervals, standard deviations, and/or p values) |
---|---|---|---|---|---|---|
• Citalopram (20-50mg, 2 months) • Paroxetine (20-50mg, 2 months) |
Perna, Bertani [19] | • Panic disorder +/- agoraphobia (DSM-IV; clinical interview + MINI) • Nil psychiatric comorbidities (physical examination and medical history assessment) |
• Nil significant physical illnesses (history and examination) • Nil concurrent psychotropic meds or psychotherapy |
• FQ (Baseline, days 7 & 60) Others: • Panic Associated Symptom Scale • Sheehan Disability Scale (SDS) |
• Citalopram: 30 started, 27 completed; 27 analysed • Paroxetine: 28 started, 25 completed; 25 analysed |
FQ Agoraphobia • Significant reductions from baseline to endpoint according to post-hoc comparisons (p not stated): • Citalopram: baseline 15.7 +/- 12.3; endpoint 9.9 +/- 9.1 • paroxetine baseline 15.6 +/- 11.9; endpoint 8.4 +/- 10.4 • Significant time effect found for antidepressant treatment (F 3.8, p<0.05) FQ Blood injury • Significant reductions from baseline to endpoint according to post-hoc comparisons (p not stated): • Citalopram: baseline 21.1 +/- 10.8; endpoint 15.6 +/- 9.9 • Paroxetine baseline 17.5 +/- 9.5; endpoint 12.4 +/- 10.1 • Significant time effect found for antidepressant treatment (F 9.0, p<0.001) |
• Desvenlafaxine (100mg or 150mg, 12 weeks) |
Cheng, DuPont [20] |
• Nil GAD, mood & psychotic disorders (DSM version not stated; method not stated) |
• Vasomotor symptoms post-menopause • Nil concurrent physical illnesses • Nil concurrent psychotropic or hormonal meds |
• POMS (Baseline, weeks 4 & 12) Others: • Greene Climacteric Scale • Menopause Symptoms–Treatment Satisfaction Questionnaire |
• 100mg: 153 started, 134 completed; 120 analysed • 150mg: 152 started, 137 completed; 117 analysed • Placebo: 153 started, 138 completed; 123 analysed |
Significant reductions in POMS Tension and POMS Depression vs placebo (p<0.05):POMS Tension • 100mg: Baseline 9.3 (SD = 6.7), change -4.1 +/- 0.4 • 150mg: Baseline 9.0 (SD = 7.2), change -3.9 +/- 0.4 • Placebo: Baseline 8.6 (SD = 6.4), change -2.4 +/- 0.4 • No statistically significant difference between doses (p value not stated) POMS Depression • 100mg: Baseline 8.3 (SD = 8.6), change -5.5 +/- 0.6 • 150mg: Baseline 8.2 (SD = 11.1), change -4.5 +/- 0.6 • Placebo: Baseline 7.4 (SD = 9.6), change -2.3 +/- 0.6 • No statistically significant difference between doses (p value not stated) |
• Escitalopram 10-20mg, 12 weeks | Alamy, Wei [21] | • Specific phobia (DSM-IV as per MINI) • Nil comorbid MDD, GAD, Social Phobia, OCD, PD, PTSD (method not stated) • Nil recent history of substance use/dependence (method not stated) • Nil lifetime BD, SCZ, organic brain syndrome (method not stated) |
• Nil significant abnormalities as per haematology, chemistry, serum pregnancy (for women) & ECG • General direction for subjects to make efforts to expose themselves to avoided situation |
• FQ (Screening, baseline, weeks 1,2,4,8 and 12) Others: • Main Phobia Scale (MPS) • CGI-I • HAM-A • MINI phobia module • Symptom Occurrence Scale |
• Escitalopram: 6 started, 5 completed; 5 analysed • Placebo: 7 started, 6 completed; 6 analysed |
No statistically significant reduction in FQ found (p not stated):FQ Agoraphobia: • Escitalopram: Baseline 3.0 (SD = 2.4), endpoint: 1.2 (SD = 1.1) • Placebo: baseline 2.9 (SD = 4.3), endpoint: 0.4 (SD = 0.8) FQ Blood Injury: • Escitalopram: Baseline 4.8 (SD = 4.1), endpoint: 1.6 (SD = 1.3) • Placebo: Baseline 6.9 (SD = 8.3), endpoint: 4.0 (SD = 7.2) |
• Fluoxetine (20mg, 6 months) |
Wood, Mortola [22] |
• Late Luteal Phase Dysphoric Disorder (SCID for DSM-III-R) • Comorbidities excluded (SCID for DSM-III-R and psychometric abnormalities during follicular phase: - BDI > = 12 - STAI > = 45 - MMPI T-score > = 70 - POMS total T-score > = 70) |
• Premenstrual Syndrome (history, examination, Calendar of Premenstrual Experiences) • Nil significant medical or gynecologic disorders (history and examination) • Nil comments on concurrent meds |
• POMS (Baseline, months 3 & 6) Others: • Calendar of Premenstrual Experiences • Beck Depression Inventory (BDI) • State-Trait Anxiety Inventory (STAI) • Minnesota Multiphasic Personality Inventory |
• 8 started, 8 completed, 8 analysed |
Significant differences between luteal phase and follicular phase when baseline T-scores of fluoxetine and placebo groups pooled (p<0.01) (individual group baselines not stated, nor was the sample from which the T-scores were derived described): • POMS Depression T-score: Luteal: 59.6 +/- 4.6 Follicular: 44.8 +/- 5.2 • POMS Tension T-score: Luteal: 56.6 +/- 3.3 Follicular: 40.5 +/- 3.6 Luteal phase: significant differences between fluoxetine and placebo (p<0.005) • POMS Depression T-score: Fluoxetine: 39.7 +/- 2.9 Placebo: 50.9 +/- 4.5 • POMS Tension T-score: Fluoxetine: 39.1 +/- 3.4 Placebo: 50.4 +/- 3.8 Follicular phase: no significant differences between placebo & fluoxetine (p not stated): • POMS Depression T-score: Fluoxetine: 39.7 +/- 2.2 Placebo: 43.4 +/- 2.9 • POMS Tension T-score: Fluoxetine: 37.8 +/- 2.9 Placebo: 43.1 +/- 3.7 |
• Fluvoxamine (150mg, 12 weeks) | Sharp, Power [23] | • Panic disorder +/- agoraphobia (DSM-III-R; clinical interview + HAM-A > = 15) • Nil depressive disorder (MADRS > = 21) • Nil OCD, paranoid PD, psychotic, manic or substance disorders (method not stated) |
• Nil severe illnesses (as per GP referral) • Nil concurrent or recent psychotropics • Nil past psychotherapy |
• FQ (baseline, weeks 7 & 12, 6 months) Others: • Hamilton Anxiety Scale • Montgomery-Asberg Depression Rating Scale (MADRS) • Panic diaries (created by investigators) |
• Fluvoxamine: 36 started, 24 completed; 29 analysed • Placebo: 37 started, 20 completed; 28 analysed |
FQ Agoraphobia • Fluvoxamine: Significant difference found vs placebo at day 84 (p<0.05) • Fluvoxamine: Significant reductions between baseline and endpoint found, t = 3.44, df = 28, p<0.002 (but baseline and end-point scores not stated) • Fluvoxamine: Significant time and interaction effects found |
• Fluvoxamine (50-200mg*, 4 weeks; *study stated a maximum range of “209mg” but this was likely a typographic error) |
Itil, Shrivastava [24] |
• Major affective disorders (RDC; clinical interview + HAMD > = 15) • Nil substance dependence (method not stated) |
• Nil significant organic disease • Nil concurrent or recent psychotropics |
• POMS (baseline, weeks 1,2,3 and 4) Others: • Clinical Global Impression [25] • Hamilton Depression Scale (HAM-D) • SCL-90 • BDI • Dosage record • Treatment Emergent Signs & Symptoms |
• Fluvoxamine: 22 started, 10 completed; 9 analysed • Imipramine: 25 started, 13 completed; 14 analysed • Placebo: 22 started, 11 completed; 14 analysed |
POMS Depression • Significant difference between fluvoxamine vs placebo at week 3 (p = 0.028) but not at week 4 (p = 0.06) |
• Nefazodone (300-600mg, 12 weeks; although results indicated final dosage range was 200-600mg; disparity not discussed) | Van Ameringen, Mancini [25] | • Social phobia–generalised (DSM-IV; SCID-I/P) • Nil exclusions (sample included MDD, dysthymia, PD with agoraphobia, OCD, alcohol abuse/dependence) |
• Nil recent or concurrent psychotropics • Nil current psychotherapy • Concurrent organic illnesses not discussed |
• FQ (baseline, weeks 4, 8 & 12) Others • BDI • STAI • SDS • Social Adjustment Scale Self-Report (SAS-SR) • Fear of Negative Evaluation Scale (FNES) • Social Avoidance and Distress Scale (SADS) • Social Anxiety Thoughts Questionnaire (SATQ) • Brief Social Phobia Scale (BSPS) • Liebowitz Panic and Social Phobic Disorders rating form (LPSPD) |
• 23 started, 21 completed, all evaluated | FQ-Agoraphobia • No significant difference between baseline (9.0, SD = 7.8) and week 12 (6.4, SD = 6.5), F2.3, df 3,51, p = 0.09. |
• Paroxetine (10-60mg, 12 weeks) |
Mancini and Ameringen [26] |
• Social phobia–generalised (DSM-III-R; SCID-I/P) • Nil exclusions (sample included MDD, dysthymia, PD, agoraphobia, PD with agoraphobia, simple phobia, OCD, GAD, alcohol abuse/dependence) |
• Nil recent or concurrent psychotropics • Nil current psychotherapy • Concurrent organic illnesses not discussed |
• FQ (baseline, weeks 4, 8 & 12) Others • BDI • STAI • SDS • SAS-SR • FNES • SADS • SATQ • LPSPD |
• 18 started, all completed |
FQ-Agoraphobia • Significant difference between baseline (11.8 +/- 10.8) and week 12 (5.8 +/- 7.1), F3.8, df 3,39, p = 0.017 |
• Sertraline (50-150mg, 12 weeks) | Alpert, Silva [27] | • MDD (DSM-III-R; semi-structure interview including DSM-III-R checklist; severity HAMD > = 18) • MMSE > = 23 • Nil other Axis I diagnoses (semi-structured interview) |
• Nil acute or unstable physical conditions • Concomitant temazepam or chloral hydrate PRN allowed • Nil other recent or concurrent psychotropics |
• POMS (Baseline, week 12) Others • Folate • HAM-D |
• Sertraline: 12 started, 12 completed, 12 analysed • Nortriptylline: 10 started, 10 completed, 10 analysed |
POMS Depression • Sertraline: Change from baseline (1.5, SD = 0.67) to endpoint (1.2, SD = 1.13) not statistically significant (p value not stated) |
• Sertraline (50mg, 100mg, 200mg; 6 weeks) |
Fabre, Abuzzahab [28] |
• MDD (DSM-III; unclear diagnostic method; severity HAMD > = 22) • Nil history of psychotic disorders or current substance abuse (method not stated) |
• Nil history of significant medical disease • PRN chloral hydrate allowed except for “nights before psychiatric scale testing” • Nil recent or other concurrent psychotropics |
• POMS (Baseline, weeks 1 to 6) Others • HAM-D • CGI • ECG • Vitals • FBE • Biochemistry • Urinalysis |
• 50mg: 95 started, 59 completed; 90 “all-patients group” (those who took medication on or after 11th day), 82 “evaluable group” (those who took 1+ dose of medication) • 100mg: 92 started, 47 completed; 89 “all-patients group”, 75 “evaluable group” • 200mg: 91 started, 39 completed; 82 “all-patients group”, 56 “evaluable group” • Placebo: 91 started, 86 “all-patients group”, 46 completed; 76 “evaluable group” |
Results for “all-patients group”:POMS Depression • Sertraline 50mg: baseline 2.8 +/- 1.1; change vs endpoint -0.5 +/- 1.1 significantly different vs placebo, p = < 0.01 • Sertraline 100mg: baseline 2.7 +/- 1.0; change vs endpoint -0.5 +/- 1.1 statistically different vs placebo, p = <0.05 • Sertraline 200mg: baseline 2.5 +/- 0.7; change vs endpoint -0.4 +/- 1.0 statistically different vs placebo, p = <0.05 • Combined: baseline 2.7 +/- 1.1; change vs endpoint -0.5 +/- 1.0 statistically different vs placebo, p = <0.01 • Placebo: baseline 2.6 +/- 1.1; change vs endpoint -0.1 +/- 0.7 • No statistically significant differences amongst different dosages (p value not stated). |
• Sertraline (50-200mg, 8 weeks) | Lydiard, Stahl [29] | • MDD (DSM III-R; Clinical interview; severity HAMD > = 18) • Nil concurrent dysthymia, bipolar, severe GAD, OCD, PTSD, psychotic disorders, severe PDs, substance dependence (Clinical interview) |
• Nil concurrent significant medical illness (history, examination, ECG & blood tests) • Temazepam or chloral hydrate PRN allowed • Nil concurrent psychotropics |
• POMS (baseline, weeks 1 to 8) Others • BDI • MADRS • Global Assessment Scale • CGI • Quality of Life Enjoyment and Satisfaction Questionnaire • Health-Related Quality of Life battery, v2 |
• Sertraline: 132 started, 96 completed, 128 analysed • Amitriptyline: 131 started, 81 completed, 127 analysed • Placebo: 129 started, 92 completed, 125 analysed |
POMS Depression • Sertraline: change from baseline 1.9 (SE = 0.08) to endpoint by -1.0 (SE = 0.08) statistically different, p<0.005 • Placebo: change from baseline 1.9 (SE = 0.08) to endpoint by -0.5 (SE = 0.08) statistically different, p<0.005 • Change in POMS-D between sertraline and placebo was significantly different, p<0.001 |
• Sertraline (50,150mg, 12 weeks) | Finkel, Richter [30] | • MDD (semi-structured interview that included DSM-III-R checklist; severity HAMD24 > = 18) • Excluded: Nil acute or chronic organic mental disorder, MMSE <24, “clinically significant psychiatric illness, active suicidality” |
• Hypnotics allowed • Nil acute or unstable medical condition or Ix abnormalities (physical exam, history, ECG, lab investigations) • Nil concurrent anticoagulants (except aspirin) • Nil current or past history of neurological disease • Nil past non-response to 6+ weeks of 2+ adequate doses of antidepressants |
• POMS Others • HAM-D • HAM-A • CGI-S/I • Q-LES-Q • MMSE • DSST • SLT • Plasma drug concentrations |
• Sertraline: 39 started, 26 finished; 7 quit due to SE; none due to lack of efficacy mean dose 100 +/- 40mg; serum levels not stated • Nortriptylline: 37 started, 19 finished; 11 quit due to SE; none due to lack of efficacy; mean dose 70+/-30mg; 29% had serum levels <50ng |
No significant difference in concomitant meds or baseline valuesPOMS Tension • baselines: not stated • change from baseline: -5.9, significantly different vs nortriptyline • time effect not factored POMS depression results not stated |
• Venlafaxine (week 1: 75mg, weeks 2–8: 150mg, 8 weeks) |
Ozdemir, Boysan [31] |
• 1st episode MDD (DSM IV-TR; SCID-I) • Nil current or past history of bipolar disorder or substance dependence (method not stated) |
• Concurrent illnesses or medications not discussed |
• POMS (baseline, weeks 1,2,4 & 8) Others • HAMD • BDI |
• Venlafaxine: 25 started, all completed • Venlafaxine + Bright Light Therapy: 25 started, all completed |
POMS Depression • Venlafaxine: baseline 37.16 +/- 11.36; endpoint 11.12 +/- 9.11; statistically significant reduction over time, p<0.001 POMS Tension • Venlafaxine: baseline 23.68 +/- 4.88; endpoint 9.60 +/- 3.93; statistically significant reduction over time, p<0.001 |