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Antidepressants.

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Background Depression is a varied illness; patients may present with symptoms such as lack of initiative, a sense of meaninglessness, depressive thoughts and/or suicidal behaviour. Problems with sleep, lack of appetite, energy, drive, anxiety and concentration are also common. Our understanding of the neurobiological causes of depression is incomplete. Reduced accessibility of monoaminergic neurotransmitters in the central nervous systems is one possible explanation. Several antidepressant drugs are available. SSRI (selective serotonin re-uptake inhibitors) and other second-generation antidepressants have been increasingly used in recent years. Antidepressants increase the accessibility of serotonin and/or noradrenalin, either by inhibiting the reuptake or inhibiting the decomposition. This does not seem to explain the effect. Methods We have systematically reviewed the literature for effect and safety in head-to-head studies of SSRI and other second-generation antidepressants used in adults with depression. The literature was identified by a systematic search in international electronic databases. We also received literature from the pharmaceutical industry. We assessed and summarised studies that fulfilled our predetermined criteria. Results 23 studies are included in the report. The 23 studies deal with 12 different comparisons out of 66 possible. Nine different antidepressants were compared. The documentation is of low quality for most of the comparisons. We did not find any differences in effect and safety in the head-to-head studies we analyzed with the exception of: Escitalopram was significantly more effective (response and remission rate) than citalopram. Loss to follow up was significantly lower for escitalopram than for citalopram. Citalopram had a significantly lower adverse event rate than venlafaxin. Mirtazapin was significantly more effective (remission rate) than paroxetin. Loss of follow up due to side effects was significantly lower for fluoksetin than for venlafaxin. Conclusion We have included 12 different head-to-head comparisons out of 66 possible. Nine different antidepressants were involved in the comparisons. We did not find any significant differences in effect and safety between the antidepressants except for the comparisons escitalopram versus citalopram, citalopram versus venlafaxin and mirtazapin versus paroxetin where we found significant differences for some of the outcomes. The conclusions are based on documentation of medium or low quality.

Antidepressants.

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Background Depression is a varied illness; patients may present with symptoms such as lack of initiative, a sense of meaninglessness, depressive thoughts and/or suicidal behaviour. Problems with sleep, lack of appetite, energy, drive, anxiety and concentration are also common. Our understanding of the neurobiological causes of depression is incomplete. Reduced accessibility of monoaminergic neurotransmitters in the central nervous systems is one possible explanation. Several antidepressant drugs are available. SSRI (selective serotonin re-uptake inhibitors) and other second-generation antidepressants have been increasingly used in recent years. Antidepressants increase the accessibility of serotonin and/or noradrenalin, either by inhibiting the reuptake or inhibiting the decomposition. This does not seem to explain the effect. Methods We have systematically reviewed the literature for effect and safety in head-to-head studies of SSRI and other second-generation antidepressants used in adults with depression. The literature was identified by a systematic search in international electronic databases. We also received literature from the pharmaceutical industry. We assessed and summarised studies that fulfilled our predetermined criteria. Results 23 studies are included in the report. The 23 studies deal with 12 different comparisons out of 66 possible. Nine different antidepressants were compared. The documentation is of low quality for most of the comparisons. We did not find any differences in effect and safety in the head-to-head studies we analyzed with the exception of: Escitalopram was significantly more effective (response and remission rate) than citalopram. Loss to follow up was significantly lower for escitalopram than for citalopram. Citalopram had a significantly lower adverse event rate than venlafaxin. Mirtazapin was significantly more effective (remission rate) than paroxetin. Loss of follow up due to side effects was significantly lower for fluoksetin than for venlafaxin. Conclusion We have included 12 different head-to-head comparisons out of 66 possible. Nine different antidepressants were involved in the comparisons. We did not find any significant differences in effect and safety between the antidepressants except for the comparisons escitalopram versus citalopram, citalopram versus venlafaxin and mirtazapin versus paroxetin where we found significant differences for some of the outcomes. The conclusions are based on documentation of medium or low quality.

Antidepressants.

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The World Health Organization defines depression as a primary contributor to the global burden of disease and predicts it will become the second leading cause of death by 2020. The need to develop effective therapies has never been so pressing. Current antidepressant drugs have several limitations. This 2010 book looks at the future of mood-disorder research, covering the identification of new therapeutic targets, establishing new preclinical models, new medicinal chemistry opportunities, and fostering greater understanding of genetic influences. These strategies are likely to help build a better picture of the disease process, and lead to new opportunities for patient stratification and treatment. The ultimate goal for this strand of research is to develop more personalized and effective treatments for this chronic and debilitating condition. This is essential reading for all those involved in psychopharmacologic drug development, and mental health clinicians seeking a preview of discoveries soon to influence their practice.

Antidepressants.

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Antidepressants - History.