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Citalopram versus other antidepressants for depression

Major depression is a severe mental illness characterised by a persistent and unreactive low mood and loss of all interest and pleasure, usually accompanied by a range of symptoms including appetite change, sleep disturbance, fatigue, loss of energy, poor concentration, psychomotor symptoms, inappropriate guilt and morbid thoughts of death. Antidepressant drugs remain the mainstay of treatment in moderate‐to‐severe major depression. During the last 20 years, selective serotonin reuptake inhibitors (SSRIs) have progressively become the most commonly prescribed antidepressants. Citalopram, one of the first SSRIs introduced in the market, is the racemic mixture of S‐ and R‐enantiomer. In the present review we assessed the evidence for the efficacy, acceptability and tolerability of citalopram in comparison with all other antidepressants in the acute‐phase treatment of major depression. Thirty‐seven randomised controlled trials (more than 6000 participants) were included in the present review. In terms of efficacy, citalopram was more efficacious than other reference compounds like paroxetine or reboxetine, but worse than escitalopram. In terms of side effects, citalopram was more acceptable than older antidepressants, like tricyclics. Based on these findings, we conclude that clinicians should focus on practical or clinically relevant considerations including differences in efficacy and side‐effect profiles.

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

Version: 2012

Antidepressants for agitation and psychosis in dementia

Psychosis and agitation frequently occur in older adults with dementia. Medications are often prescribed to treat these symptoms and antidepressants are increasingly used for these symptoms. We reviewed the evidence for the effectiveness and safety of antidepressants for the treatment of agitation and psychosis in older adults with dementia. We classified antidepressants based on their mechanism of action and included studies that compared antidepressants to treatment with either placebo or other medications frequently used to manage these symptoms. A total of nine studies (including 692 individuals) were identified, four comparing selective serotonin reuptake inhibitors (SSRIs) to placebo, three comparing SSRIs to typical antipsychotics, and one study comparing SSRIs to atypical antipsychotics. One study compared the antidepressant trazodone to placebo, and two compared trazodone to haloperidol. Most of the studies included in the review were relatively small and of uncertain risk of bias due to methodological issues. The SSRIs sertraline and citalopram were associated with a modest reduction in symptoms of agitation and psychosis when compared to placebo in two studies. There were few other statistically significant differences in changes in agitation or psychosis or in most measures of medication tolerability for SSRIs or trazodone when compared to placebo or the antipsychotic haloperidol. We conclude that there is some evidence to support the use of certain antidepressants for agitation and psychosis in dementia and further studies are required to determine the effectiveness and safety of SSRIs and trazodone in managing these symptoms.

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

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

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

Escitalopram versus other antidepressive agents for depression

Although pharmacological and psychological interventions are both effective for major depression, antidepressant drugs remain the mainstay of treatment. During the last 20 years, selective serotonin reuptake inhibitors (SSRIs) have progressively become the most commonly prescribed antidepressants. Escitalopram, the last SSRI introduced in the market, is the pure S‐enantiomer of the racemic citalopram. In the present review we assessed the evidence for the efficacy, acceptability and tolerability of escitalopram in comparison with all other antidepressants in the acute‐phase treatment of major depression. Twenty‐two randomised controlled trials (about 4000 participants) were included in the present review. Escitalopram appears to be suitable as first‐line antidepressant treatment for people with moderate to severe major depression. It has been compared with only a few other antidepressants and so we are unable to say whether it is better, worse or the same as many of the other drugs used in practice. However, it did perform better than citalopram when we brought together the results of six studies in nearly two thousand patients

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

Version: 2016

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

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

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

S‐adenosyl methionine for depression in adults

Depression is a common, recurrent mood disorder. Usually, affected people experience symptoms such as low mood and a loss of interest or pleasure. People with depression also often experience some of the following symptoms: weight loss or gain; a decrease or increase in appetite, insomnia or hypersomnia; restlessness or fatigue as well as excessive guilt; feelings of worthlessness, poor concentration and indecisiveness; recurrent thoughts of death and suicidal thoughts. The medicines most often used in the treatment of depression are antidepressants.

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

Version: 2016

Paroxetine versus other anti‐depressive agents for depression

Major depression is a severe mental illness characterised by a persistent and unreactive low mood and loss of all interest and pleasure, usually accompanied by a range of symptoms such as appetite change, sleep disturbance, fatigue, loss of energy, poor concentration, inappropriate guilt and morbid thoughts of death. Although medication and psychological treatments are both effective for major depression, antidepressant drugs remain the mainstay of treatment in moderate to severe major depression. However, head‐to‐head comparisons of such drugs provide contrasting findings as to whether they are effective.

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

Version: 2014

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

Anti‐depressant therapies may be able to help relieve depression in people with Parkinson's disease but more research is needed on safety and effectiveness.

Parkinson's disease can lead to psychiatric as well as physical symptoms, the most common of which is depression. Oral antidepressants, electroconvulsive therapy or behavioural therapy are currently used in the treatment of depression in Parkinson's disease. No trials were found examining the efficacy of electroconvulsive therapy or behavioural therapy. We identified three trials which examined antidepressant drugs. The review found that there is not enough evidence from the trials about the effects of antidepressant drugs for the treatment of depression in people with Parkinson's disease. Adverse effects in trials so far have not been severe, and included visual hallucinations and confusion.

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

Version: 2009

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

Selective serotonin re‐uptake inhibitors (SSRIs) versus placebo for obsessive compulsive disorder (OCD)

Obsessive compulsive disorder (OCD) is a common and disabling disorder, which frequently follows a chronic course. It is characterised by intrusive thoughts of imagined harm, which are difficult to dispel, and ritualistic behaviour such as repetitive washing of hands and repetitive checking for risk of harm. Individual randomised controlled trials have demonstrated that antidepressants are effective for OCD. This review summarises all the available evidence for one class of antidepressant drugs, the selective serotonin re‐uptake inhibitors (SSRIs) (including citalopram, fluoxetine, fluvoxamine, paroxetine and sertraline) compared to placebo in the treatment of OCD in adults. The review included 17 studies (3097 participants), and showed that SSRIs were effective in reducing the symptoms of OCD. Based on 13 studies (2697 participants), the review showed that people receiving SSRIs were nearly twice as likely as those receiving placebo to achieve clinical response (defined as a 25% or more reduction in symptoms). Indirect comparisons of effectiveness suggested that although individual SSRI drugs were similar in their effectiveness, they differed in terms of their adverse effects. The most common adverse effect reported by participants was nausea. Further studies involving head to head comparisons between different SSRI drugs are required to obtain more reliable information on differences between SSRIs, both in terms of effectiveness and adverse effects.

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

Version: 2009

Psychosocial interventions for premature ejaculation

Premature ejaculation is a frequent sexual dysfunction. It is characterized by ejaculation that always or nearly always occurs prior to or within about one minute of vaginal penetration. It is also characterized by the inability to delay ejaculation on all or nearly all vaginal penetrations, and its personal consequences are distress, bother, frustration and/or the avoidance of sexual intimacy. Although psychological issues are present in most of patients with PE, as a cause or as a consequence, research on the effects of psychological approaches for PE is not clear. The early success reports (97.8%) of Masters and Johnson have not be replicated. This review assessed the efficacy of psychosocial interventions for PE and found four trials involving 253 PE patients. Overall, there is weak and inconsistent evidence regarding the effectiveness of psychological interventions for the treatment of premature ejaculation.

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

Version: 2011

Ketamine and other glutamate receptor modulators for depression in adults

Depression is one of the most common mental disorders, estimated to affect 350 million people worldwide. Antidepressant medication tends to be given as a first treatment for people with major depression. Antidepressants are however only effective in about two out of three people. Effective alternative medications to treat depression are needed. A new group of medications is called ‘glutamate receptor modulators’. This group includes the medicine ketamine. In this review we examined the evidence for glutamate receptor modulators, including ketamine, as a treatment for depression.

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

Version: 2015

Selective serotonin reuptake inhibitors (SSRIs) for premenstrual syndrome

Premenstrual syndrome (PMS) is a common cause of physical, psychological and social problems in women of reproductive age. PMS is distinguished from 'normal' premenstrual symptoms by the degree of distress and disruption it causes. Symptoms occur during the period leading up to the menstrual period and are relieved by the onset of menstruation. Common symptoms include irritability, depression, anxiety and lethargy. A clinical diagnosis of PMS requires that the symptoms are confirmed by prospective recording (that is recorded as they occur) for at least two menstrual cycles and that they cause substantial distress or impairment to daily life. It is estimated that approximately one in five women of reproductive age are affected. PMS can severely disrupt a woman's daily life and some women seek medical treatment. Researchers in The Cochrane Collaboration reviewed the evidence about the effectiveness and safety of selective serotonin reuptake inhibitors (SSRIs) for treating PMS. They examined the research up to February 2013.

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

Version: 2013

Antidepressants for people with epilepsy and depression

Depressive disorders occur in approximately one‐third of people with epilepsy, often requiring antidepressant treatment. However, depression often goes untreated in people with epilepsy, partly due to fear that antidepressants might cause seizures. There are different classes of antidepressants, however they all aim to increase key neurotransmitters in the brain, thereby alleviating depressive symptoms.

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

Version: 2014

Comparing Antiepileptics for Bipolar Disorder, Migraines, Fibromyalgia, and Chronic Pain

How do antiepileptics compare in treating bipolar disorder?

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

Version: October 1, 2010

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