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Sertraline versus other antidepressive agents for depression

Depression is the fourth leading cause of disease burden worldwide and is expected to show a rising trend over the next 20 years. Depression is associated with a marked personal, social and economic morbidity, loss of functioning and productivity, and creates significant demands on service providers in terms of workload. 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. Sertraline, one of the first SSRIs introduced in the market, is a potent and specific inhibitor of serotonin uptake into the presynaptic terminal, with a modest activity as inhibitor of dopamine uptake. In the present review we assessed the evidence for the efficacy, acceptability and tolerability of sertraline in comparison with all other antidepressants in the acute‐phase treatment of major depression. Fifty‐nine randomised controlled trials (about 10,000 participants) were included in the review. The review showed evidence of differences in efficacy, acceptability and tolerability between sertraline and other antidepressants, with meta‐analyses highlighting a trend in favour of sertraline over other antidepressants, both in terms of efficacy and acceptability, in a homogeneous sample of clinical trials, using conservative statistical methods. The included studies did not report on all the outcomes that were pre‐specified in the protocol of this review. Outcomes of clear relevance to patients and clinicians, in particular, patients and their carers' attitudes to treatment, their ability to return to work and resume normal social functioning, were not reported in the included studies. Nevertheless, based on currently available evidence, results from this review suggest that sertraline might be a strong candidate as the initial choice of antidepressant in people with acute major depression.

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

Version: 2010

Drug therapy for obstructive sleep apnoea in adults

Obstructive sleep apnoea (OSA) is caused by collapse of the upper airway. The mainstay of medical treatment is continuous positive airways pressure (CPAP), delivered through a mask during sleep, aiming to keep the airway opened. Drug therapy has been proposed for individuals with mild OSA and those intolerant of CPAP.

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

Version: 2013

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

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

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

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

Assessment of the Need to Update Comparative Effectiveness Reviews: Report of an Initial Rapid Program Assessment (2005–2009) [Internet]

AHRQ recognizes that periodic assessments of the evidence base supporting each of the comparative effectiveness reviews is an important and necessary part of the Effective Health Care (EHC) Program. The rapidity with which new research findings accumulate makes it imperative that the evidence be assessed periodically to determine the need for a full-scale update. The EHC Program, then, initiated concurrent and parallel work to address this need both methodologically and programmatically. The development of methods guidance for updating was initiated to inform the research of systematic reviewers. This methodologic guidance will supplement the EHC Methods Guide for Comparative Effectiveness Reviews (www.effectiveheathcare.gov). In parallel with the methods effort, an initial, rapid program assessment was commissioned to assess the need for the findings of the CERs completed to that point to be updated. The Southern California Evidence-based Practice Center (SCEPC) was tasked with conducting this assessment. Findings from the assessment were presented to AHRQ for consideration within the usual program criteria to prioritize the topics for updating within the EHC Program. This document presents the findings from the assessment for public information and transparency.

Agency for Healthcare Research and Quality (US).

Version: September 10, 2009
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Post-Traumatic Stress Disorder: The Management of PTSD in Adults and Children in Primary and Secondary Care

This guideline has been developed to advise on the treatment and management of post-traumatic stress disorder (PTSD). The guideline recommendations have been developed by a multidisciplinary team of healthcare professionals, PTSD sufferers and guideline methodologists after careful consideration of the best available evidence. (The term ‘PTSD sufferer’ was chosen for use in the guideline on the basis of a survey conducted by sufferer members of the Guideline Development Group. People with the disorder were presented with a range of options such as ‘people with PTSD’, ‘patients with PTSD’ and ‘PTSD sufferer’ and asked to indicate which term they preferred; ‘PTSD sufferer’ was the term favoured by the majority.) It is intended that the guideline will be useful to clinicians and service commissioners in providing and planning high-quality care for those with PTSD while also emphasising the importance of the experience of care for patients and their families.

NICE Clinical Guidelines - National Collaborating Centre for Mental Health (UK).

Version: 2005
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Nonpharmacological Versus Pharmacological Treatments for Adult Patients With Major Depressive Disorder [Internet]

To compare the benefits and harms of second-generation antidepressants (SGAs), psychological, complementary and alternative medicine, and exercise treatment options as first-step interventions for adult outpatients with acute-phase major depressive disorder (MDD), and as second-step interventions for patients with MDD who did not achieve remission after a first treatment attempt with SGAs.

Comparative Effectiveness Reviews - Agency for Healthcare Research and Quality (US).

Version: December 2015
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Lithium or an atypical antipsychotic drug in the management of treatment-resistant depression: a systematic review and economic evaluation

Report finds that treatment strategy involving augmentation of selective serotonin reuptake inhibitors with lithium or an atypical antipsychotic drug (AAP) is likely to be beneficial in people with treatment-resistant depression.

Health Technology Assessment - NIHR Journals Library.

Version: November 2013
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Hot Flashes and Night Sweats (PDQ®): Health Professional Version

Expert-reviewed information summary about causes and treatment of hot flashes and night sweats in cancer patients.

PDQ Cancer Information Summaries [Internet] - National Cancer Institute (US).

Version: July 14, 2017

Depression (PDQ®): Health Professional Version

Expert-reviewed information summary about the diagnosis, assessment, and treatment of depression in adults and children who have cancer.

PDQ Cancer Information Summaries [Internet] - National Cancer Institute (US).

Version: May 2, 2017

Development of DEMQOL-U and DEMQOL-PROXY-U: generation of preference-based indices from DEMQOL and DEMQOL-PROXY for use in economic evaluation

This study has developed dementia specific preference based measures for use in economic evaluation. The DEMQOL instruments can be used alongside a generic preference based measure such as the EQ-5D in future studies of interventions in dementia.

Health Technology Assessment - NIHR Journals Library.

Version: February 2013
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Sleep Disorders (PDQ®): Health Professional Version

Expert-reviewed information summary about causes and management of sleep disorders in people with cancer.

PDQ Cancer Information Summaries [Internet] - National Cancer Institute (US).

Version: March 10, 2016

Antidepressants in Elderly Patients with Major and Minor Depression: A Review of Clinical Effectiveness and Guidelines [Internet]

While clinical trials of antidepressants may include some individuals over the age of 65, it is not clear that evidence of safety and efficacy in such subgroup analyses are reflective of this age group more broadly. The generalizability of outcome data across populations can potentially be uncertain and the comparative efficacy of different antidepressants in older adults could potentially differ than what is seen in younger populations. As well, age-related changes that affect the pharmacokinetics and pharmacodynamics of drugs can affect the safety and potential harms with antidepressants in older adults. Older adults are at increased risk of anticholinergic side effects (common to a number of antidepressant classes), and orthostatic and sedative effects. These effects can exacerbate underlying conditions such as cardiovascular disease, cognitive impairment, delirium and can increase the risk of falls and fractures.

Rapid Response Report: Summary with Critical Appraisal - Canadian Agency for Drugs and Technologies in Health.

Version: August 17, 2015
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Pruritus (PDQ®): Health Professional Version

Expert-reviewed information summary about pruritus (itching of the skin) as a complication of cancer or its treatment. Approaches to the management and treatment of pruritus are discussed.

PDQ Cancer Information Summaries [Internet] - National Cancer Institute (US).

Version: May 5, 2016

Selective serotonin and norepinephrine reuptake inhibitors (SNRI) for patients with depression: Executive summary of final report A05-20A, Version 1.0

The aim of this research is to assess the benefit of the selective serotonin and norepinephrine reuptake inhibitors (SNRI) venlafaxine and duloxetine in treating the acute phase of depression, in maintenance therapy (relapse prevention), and in recurrence prevention compared to treatment with placebo, treatment with other antidepressants, each other, in each case in adult patients with depression with reference to patient-relevant outcomes.

Institute for Quality and Efficiency in Health Care: Executive Summaries [Internet] - Institute for Quality and Efficiency in Health Care (IQWiG).

Version: June 17, 2009

Self-Harm: Longer-Term Management

This is the first NICE guideline on the longer-term management of both single and recurrent episodes of self-harm.

NICE Clinical Guidelines - National Collaborating Centre for Mental Health (UK).

Version: 2012
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Findings of Bayesian Mixed Treatment Comparison Meta-Analyses: Comparison and Exploration Using Real-World Trial Data and Simulation [Internet]

Specific objectives were to examine the following: (1a) how results of Bayesian mixed treatment comparison (MTC) methods compare with several commonly considered frequentist indirect methods; (1b) how Bayesian MTC methods perform for different evidence network patterns; (2) how meta-regression can be used with Bayesian MTC meta-analysis to explore heterogeneity; and (3) how findings of Bayesian MTC meta-analyses compare for different numbers of studies and different network pattern assumptions. For objectives 1 and 2, we aimed to conduct case studies using data from two recent comparative effectiveness reviews (CERs). For objective 3, we aimed to use simulated data.

Methods Research Reports - Agency for Healthcare Research and Quality (US).

Version: February 2013
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Methods for the estimation of the National Institute for Health and Care Excellence cost-effectiveness threshold

Study shows an empirically-based and explicit quantification of the scale of opportunity costs the NHS faces when considering whether or not the health benefits associated with new technologies are expected to offset the health that is likely to be forgone elsewhere in the NHS. As such, it provides a basis for determining the appropriate threshold for National Institute for Health and Care Excellence decisions as well as those made centrally by the NHS and Department of Health more generally.

Health Technology Assessment - NIHR Journals Library.

Version: February 2015
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