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Fluoxetine compared with other antidepressants for depression in adults

Depression is a severe mental illness characterised by a persistent low mood and loss of all interest and pleasure, usually accompanied by a range of symptoms such as appetite change, sleep disturbance and poor concentration. The predominant treatment options for depression are drugs and psychological therapies, but antidepressant drugs are the most common treatment for moderate to severe depression. Fluoxetine, one of the first new generation antidepressants, is an extremely popular drug treatment for depression. However, findings from studies comparing fluoxetine with other antidepressants are controversial. In this systematic review, the efficacy and tolerability of fluoxetine was compared with other antidepressants for the acute treatment of depression.

Cochrane Database of Systematic Reviews: Plain Language Summaries [Internet] - John Wiley & Sons, Ltd.

Version: 2013

Pharmacotherapy for weight loss in adults with type 2 diabetes mellitus

Obesity is closely related to type 2 diabetes and weight reduction is an important part of the care delivered to obese persons with diabetes. This review of drugs for weight loss among adults with type 2 diabetes revealed weight loss of between 2.0 and 5.1 kg for fluoxetine, orlistat and sibutramine at follow‐up of up to 57 weeks. The long‐term effects remain uncertain. Adverse events were common in all three drugs: gastrointestinal side effects with orlistat; tremor, somnolence, and sweating with fluoxetine; and palpitations with sibutramine. There were few studies examining other drugs used for weight loss in populations with diabetes.

Cochrane Database of Systematic Reviews: Plain Language Summaries [Internet] - John Wiley & Sons, Ltd.

Version: 2009

Medication, psychotherapy, or a combination of both, in treating body dysmorphic disorder

Body dysmorphic disorder (BDD) is a condition characterised by a distressing and disabling preoccupation with an imagined or slight defect in appearance. This causes people with this disorder either significant distress or disrupts their daily functioning (or both). There has been a growing recognition that BDD is common, and is associated with significant illness and disability. There is also some evidence that it may respond to pharmacotherapy and psychotherapy. Our systematic review of randomised controlled trials assesses the effects of drug treatment or psychotherapy when used on their own or in combination. We found five eligible trials, including three of psychotherapy (cognitive behavioural therapy (CBT) and exposure and response prevention (ERP)) and two of medication (the serotonin reuptake inhibitors (SRIs) fluoxetine and clomipramine). In the only placebo‐controlled medication trial included in our review, people with BDD treated with fluoxetine were more likely to respond (56%, 19 out of 34) than those allocated placebo (18%, 6 out of 33). Symptoms became less severe after treatment with both medication and psychotherapy. Adverse events were mild to moderate in severity and none of the people in the active treatment groups were reported to have dropped out of the studies because of treatment‐emergent adverse events. There is preliminary evidence from one trial of CBT that the effects of CBT may persist once treatment has ended. Treatment response in the medication trials was not effected by the degree to which people had insight into their condition. Although few controlled trials have been done, and those that have been conducted were small, indicating that our findings should be used with caution unless confirmed by larger studies (some of which are ongoing), the results suggest that treatment with both medication or psychotherapy can be effective in treating the symptoms of body dysmorphic disorder.

Cochrane Database of Systematic Reviews: Plain Language Summaries [Internet] - John Wiley & Sons, Ltd.

Version: 2009

Duloxetine versus other antidepressive agents for depression

Although pharmacological and psychological interventions are both effective for major depression, antidepressant drugs remain the mainstay of treatment in moderate to severe major depression. During the last 20 years, newer compounds (such as selective serotonin reuptake inhibitors and dual action agents such as serotonin noradrenalin reuptake inhibitors) have progressively become the most commonly prescribed antidepressants. Duloxetine hydrochloride, one of the most recent antidepressants introduced in the market, is a selective serotonin noradrenergic reuptake inhibitor for oral administration. In the present review we assessed the evidence for the efficacy, acceptability and tolerability of duloxetine in comparison with all other antidepressants in the acute‐phase treatment of major depression. Sixteen randomised controlled trials (5735 participants) were included. Duloxetine was not more effective than some other new antidepressant agents in the acute‐phase treatment of major depression, and it was less well tolerated than escitalopram and venlafaxine as more patients allocated to duloxetine withdrew treatment before study end. However, due to the limited number of studies per comparison these results should be interpreted with caution.

Cochrane Database of Systematic Reviews: Plain Language Summaries [Internet] - John Wiley & Sons, Ltd.

Version: 2012

Second‐generation antidepressants for winter depression

Seasonal affective disorder (winter depression) is a type of depression that recurs in the autumn and lasts until the spring. It is similar to regular depression except sufferers are usually very tired and have an increase in their appetite. It is more common in countries with few daylight hours in winter. One of the mainstays of treatment for all depression, including winter depression, are second‐generation antidepressants (SGAs) such as selective serotonin reuptake inhibitors (SSRIs), and serotonin and norepinephrine reuptake inhibitors (SNRIs). It is not clear how well these drugs work for winter depression and how they compare to each other or to other types of therapy such as light therapy.

Cochrane Database of Systematic Reviews: Plain Language Summaries [Internet] - John Wiley & Sons, Ltd.

Version: 2011

Newer antidepressants for depression in children and adolescents

Depression is common in young people and can contribute to a variety of negative outcomes, such as poor academic functioning, difficulties in peer and family relationships, increases in substance use, and both attempted and completed suicide. This review contained 19 trials (with a total of 3353 participants) testing the effectiveness of newer generation antidepressants (these are antidepressants developed and used since tricyclic antidepressants were developed). These include the well‐known selective serotonin reuptake inhibitors that have an impact primarily on the brain chemical called serotonin, as well as several other newer classes of antidepressants now being used, which aim to target noradrenaline and dopamine as well as serotonin and include selective norepinephrine reuptake inhibitors (SNRIs), norepinephrine reuptake inhibitors (NRIs), norepinephrine dopamine reuptake inhibitors (NDRIs), norepinephrine dopamine disinhibitors (NDDIs) and tetracyclic antidepressants (TeCAs)) for the treatment of depression in children and adolescents. Based on 14 of the trials (2490 participants in total), there was evidence that those treated with an antidepressant had lower depression severity scores than those on placebo, however, the size of this difference was small. Based on 17 trials (3229 participants in total), there was evidence of an increased risk (64%) of suicide‐related outcomes for those on antidepressants compared with those given placebo. Where rates of adverse events were reported, this was higher for those prescribed an antidepressant. There was no evidence that one particular type of newer generation antidepressant had a larger effect than the others when compared to placebo.

Cochrane Database of Systematic Reviews: Plain Language Summaries [Internet] - John Wiley & Sons, Ltd.

Version: 2012

Selective serotonin reuptake inhibitors for treating people with autism spectrum disorders

Autism spectrum disorders (ASD) are characterised by problems with social interaction and communication, as well as repetitive behaviours and limited activities and interests. Selective serotonin reuptake inhibitors (SSRIs) are a class of antidepressants that are sometimes given to reduce anxiety or obsessive‐compulsive behaviours. We found nine trials, involving 320 people, which evaluated four SSRIs: fluoxetine, fluvoxamine, fenfluramine and citalopram. Five studies included only children and four studies included only adults. One trial enrolled 149 children, but the other trials were much smaller. We found no trials that evaluated sertraline, paroxetine or escitalopram. There is no evidence to support the use of SSRIs to treat autism in children. There is limited evidence, which is not yet sufficiently robust, to suggest effectiveness of SSRIs in adults with autism. Treatment with an SSRI may cause side effects. Decisions about the use of SSRIs for established clinical indications that may co‐occur with autism, such as obsessive‐compulsive disorder and depression in adults or children, and anxiety in adults, should be made on a case‐by‐case basis.

Cochrane Database of Systematic Reviews: Plain Language Summaries [Internet] - John Wiley & Sons, Ltd.

Version: 2013

Selective serotonin reuptake inhibitors for stroke recovery

Selective serotonin reuptake inhibitors (SSRIs) are a class of drugs that have been in use for many years, mainly for the treatment of mood disorders such as depression. Animal studies have shown that SSRIs may have other direct effects on the brain, such as encouraging the development of new brain cells. If this also occurs in humans, recovery from stroke may be improved. This review brought together the results of 52 trials (4060 participants) of SSRIs in people who had had a stroke in the previous year, to find out whether SSRIs might reduce dependency and disability. The review found promising evidence that SSRIs might improve recovery after stroke, even in patients who were not depressed. Large trials are now needed to confirm or refute these findings, and to determine whether SSRIs increase the risk of side effects such as seizures. If effective, SSRIs would be a low‐cost, simple and widely applicable treatment for patients with stroke.

Cochrane Database of Systematic Reviews: Plain Language Summaries [Internet] - John Wiley & Sons, Ltd.

Version: 2012

Antidepressants for postnatal depression

Postnatal depression is a common disorder that can have short‐ and long‐term adverse effects on the mother, the new infant and the family as a whole. Antidepressants are commonly used as the first treatment option for adults with moderate to severe depression, but there is little evidence on whether antidepressants are an effective and safe choice for the treatment of this disorder in the postnatal period. This review was undertaken to evaluate the effectiveness of different antidepressants and to compare their effectiveness with other forms of treatment (e.g. psychosocial interventions such as peer support, psychological interventions such as cognitive behavioural therapy), placebo or treatment as usual.

Cochrane Database of Systematic Reviews: Plain Language Summaries [Internet] - John Wiley & Sons, Ltd.

Version: 2014

Antidepressants for treating depression in adults with end‐stage kidney disease treated with dialysis

People treated with dialysis frequently experience depression and anxiety. Depression in this situation is linked to poor quality of life and increased complications, such as needing to be admitted to hospital, or stopping dialysis treatment. Patients, their families, and health care workers agree that caring for depression symptoms appropriately and finding effective treatments is really important. Antidepressant drugs may not be removed from the body as quickly for people with kidney disease and so may cause more side effects. Despite depression being very common and treatment having potentially different side‐effects compared with people without kidney disease, a previous version of this review in 2005 found only a single research study. It is unknown whether antidepressant treatment works and is safe for people with kidney failure.

Cochrane Database of Systematic Reviews: Plain Language Summaries [Internet] - John Wiley & Sons, Ltd.

Version: 2016

Title: Chinese herbal medicines for menopausal symptoms

Background: Menopause usually takes place when a woman is around 51 years of age. Women can experience symptoms such as hot flushes, sweats, poor sleep, joint pains, anxiousness, dry skin and vagina when the organs which produce female hormones slow down. Usually hormone therapy (HT) is prescribed to reduce the symptoms.

Cochrane Database of Systematic Reviews: Plain Language Summaries [Internet] - John Wiley & Sons, Ltd.

Version: 2016

Comparing Fibromyalgia Drugs

How do drugs for fibromyalgia compare in improving symptoms?

PubMed Clinical Q&A [Internet] - National Center for Biotechnology Information (US).

Version: June 12, 2011

Drug interventions for the treatment of obesity in children and adolescents

Across the world more children and adolescents are becoming overweight and obese. These children and adolescents are more likely to have health problems, both while as children or adolescents and in later life. More information is needed about what works best for treating this problem recognising that so‐called lifestyle changes (diet, exercise and counselling) have limited efficacy.

Cochrane Database of Systematic Reviews: Plain Language Summaries [Internet] - John Wiley & Sons, Ltd.

Version: 2016

Drug treatment for borderline personality disorder

Many people with borderline personality disorder (BPD) receive medical treatment. However, there are no drugs available for BPD treatment specifically. A certain drug is most often chosen because of its known properties in the treatment of associated disorders, or BPD symptoms that are also known to be present in other conditions, such as depressive, psychotic, or anxious disorders. BPD itself is characterised by a pervasive pattern of instability in affect regulation (with symptoms such as inappropriate anger, chronic feelings of emptiness, and affective instability), impulse control (symptoms: self‐mutilating or suicidal behaviour, ideation, or suicidal threats to others), interpersonal problems (symptoms: frantic efforts to avoid abandonment, patterns of unstable relationships with idealization and depreciation of others), and cognitive‐perceptual problems (symptoms: identity disturbance in terms of self perception, transient paranoid thoughts or feelings of dissociation in stressful situations). This review aimed to summarise the current evidence of drug treatment effects in BPD from high‐quality randomised trials.

Cochrane Database of Systematic Reviews: Plain Language Summaries [Internet] - John Wiley & Sons, Ltd.

Version: 2010

Interventions for preventing weight gain after smoking cessation

When giving up smoking, most people put on weight. Many smokers are concerned about this and say it may put them off making an attempt quit. Some studies show that weight gain also leads to people resuming smoking after an initially successful quit attempt. On the other hand, there are good reasons to believe that trying to limit weight gain may reduce the chance of stopping smoking. Several drug and behavioural programmes to limit post cessation weight gain have been tested. Of the drug treatments, naltrexone showed the most promise, but there were no data on its effects on weight once drug treatment stopped and there was not enough evidence to judge its effects on long term quitting. Weight management education alone did not limit weight gain and may undermine cessation. Weight management education with personalised support giving feedback on personal goals and a personal energy prescription limited weight gain and there was no evidence that it undermined cessation. Intermittent use of a VLCD improved cessation success and weight gain in the short term but not in the longer term.

Cochrane Database of Systematic Reviews: Plain Language Summaries [Internet] - John Wiley & Sons, Ltd.

Version: 2012

Do medications used to treat depression help smokers who are trying to quit

Some medications and supplements that have been used to treat depression (antidepressants) have been tested to see whether they also help people who are trying to stop smoking. Two antidepressants, bupropion (Zyban) and nortriptyline, are sometimes prescribed to help with quitting smoking. This review set out to determine if using antidepressants increased people's likelihood of successfully quitting smoking at six months or longer and to determine the safety of using these medications to help quit smoking.

Cochrane Database of Systematic Reviews: Plain Language Summaries [Internet] - John Wiley & Sons, Ltd.

Version: 2016

Antidepressants compared with placebo for bulimia nervosa

Individual antidepressants are effective for the treatment of bulimia nervosa when compared to placebo treatment, with an overall greater remission rate but a higher rate of dropouts.

Cochrane Database of Systematic Reviews: Plain Language Summaries [Internet] - John Wiley & Sons, Ltd.

Version: 2009

Selective serotonin reuptake inhibitors (SSRIs) for fibromyalgia 

Researchers of the Cochrane Collaboration conducted a review of research about the effects of antidepressants classified as serotonin reuptake inhibitors (SSRIs) on fibromyalgia. After searching for all relevant studies up to June 2014, they found seven studies that compared SSRIs with a fake medication. These studies included a total of 383 people. Most participants were middle‐aged women. The SSRIs that they studied were citalopram, fluoxetine and paroxetine. Five studies were each funded by pharmaceutical companies, and two studies were funded by public institutions.

Cochrane Database of Systematic Reviews: Plain Language Summaries [Internet] - John Wiley & Sons, Ltd.

Version: 2015

The effect of antidepressants for women with polycystic ovary syndrome

The prevalence of depression in women with polycystic ovary syndrome (PCOS) is high; a study has shown it to be four times that of women without PCOS. Therefore, systematic evaluation of the effectiveness and safety of antidepressants for women with PCOS is important. We found no evidence to support the use or non‐use of antidepressants in women with PCOS, with or without depression. Well‐designed and well‐conducted randomised controlled trials with double blinding should be conducted.

Cochrane Database of Systematic Reviews: Plain Language Summaries [Internet] - John Wiley & Sons, Ltd.

Version: 2013

Are there any effective interventions to help individuals with depression to quit smoking?

People with depression are very often heavy smokers. We wanted to know whether treatments to help people quit smoking are effective for people with current depression or with a history of depression. In this review, treatments were divided into those with or without specific attention to handling depression. We found that smoking cessation treatments with specific attention to handling depression helped smokers who suffered from depression to quit. Psychosocial 'mood management' interventions, where participants learn how to handle depressive symptoms with psychological techniques, were effective in those with current depression and with a history of it. Bupropion, an antidepressant medication to help quit smoking, has been shown to be effective for smoking cessation in healthy smokers. Our findings show that bupropion may benefit smokers with a history of depression as well. However, this was not found for those with current depression. There was a lack of evidence for the effectiveness of other antidepressants to help smokers with a history of depression to quit. There was also not enough evidence for the use of antidepressants in smokers with current depression. Although treatments without specific attention to handling depression, such as nicotine replacement therapy and standard psychosocial smoking cessation interventions, have been shown to help other groups of people to quit smoking, there was not enough evidence to show that they were helpful in people with a history of or with current depression.

Cochrane Database of Systematic Reviews: Plain Language Summaries [Internet] - John Wiley & Sons, Ltd.

Version: 2013

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