Tricyclic Antidepressants vs. SSRIs in Depressed Patients

Although depression is the most common and costly mental health problem managed in primary care, treatment recommendations are based predominantly on studies of patients in subspecialty centers. Research indicates that primary care patients with major depression may have a different disease etiology and progression. This has led to concern about the relevance of current recommendations, particularly those based on drug efficacy. MacGillivray and colleagues reviewed the evidence for efficacy and tolerability of selective serotonin reuptake inhibitors (SSRIs) and tricyclic antidepressants in the treatment of depression in patients managed in primary care.

The authors searched the Cochrane Collaboration database, reviewed reference lists of previously identified studies, and contacted experts to identify all studies comparing SSRIs with tricyclic antidepressants in adult primary care patients with depression. The primary outcomes were differences in depression scores and the proportion of patients who responded to treatment. Secondary outcomes were the total number of patients who withdrew from treatment and the number who withdrew because of side effects.

The authors identified 284 studies, of which only 11, involving a total of 2,954 patients, met criteria for inclusion in the review. Study participants were predominantly white Europeans averaging 40 to 45 years of age. About three fourths of the participants were women. The studies varied considerably in quality, and four failed to meet minimum criteria on at least one key methodologic component. All of the studies had some form of commercial sponsorship.

Only six studies met criteria for inclusion in the efficacy analysis based on changes in depression scores. Of these studies, only three reported data in an unambiguous format. Overall, the two classes of antidepressants did not differ significantly in efficacy. The slightly better performance of tricyclics that emerged when all six studies were analyzed disappeared when only the three unambiguous studies were analyzed. Three studies (totaling 740 patients) that reported clinical global impression as the measure of improvement also failed to show a statistically significant difference between the two classes of antidepressants.

Assessment of tolerability was based on six studies (2,375 patients). A significantly lower proportion of patients withdrew from treatment with an SSRI (20.7 percent) than from treatment with a tricyclic antidepressant (27.9 percent). The relative risk of withdrawal was calculated as 0.78 in favor of SSRIs. Seven studies provided data specifically on withdrawal because of adverse events. A significantly lower proportion of patients withdrew because of adverse events during treatment with SSRIs (11.6 percent) than with tricyclics (17 percent).

The authors emphasize that although only limited high-quality data are currently available, SSRIs and tricyclics appear to be comparable in short-term efficacy in primary care, but SSRIs appear to be better tolerated by patients. The authors call for much more high-quality research on the management of depression in primary care.

Depression Medication And Drugs

Finding the best antidepressant for you can be a challenge. Don't be surprised if you have to try more than one drug before you find one that works well for you. Many doctors continue to rely on well established drugs known as tricyclic antidepressants. These drugs are often very effective in relieving depression, but they usually take some time two to six weeks to become fully effective. They may also have unpleasant side effects such as constipation, dry mouth, blurred vision, urinary retention and drowsiness, and they may be less safe for people with heart disease than some of the newer drugs. Even though these side effects diminish or disappear after a few weeks, many older people find them especially difficult to tolerate and they may stop taking the medication altogether.

Your doctor may recommend an older tricyclic antidepressant such as imipramine (Tofranil) and doxepin (Sinequan). Although these can work well, a newer group of tricyclics for example, nortriptyline (Aventyl) and desipramine (Norpramin) seem to be better tolerated, especially by older people. In recent years a new generation of antidepressant drugs known as SSRIs (selective serotonin reuptake inhibitors) has been developed. These drugs include fluoxetine (Prozac), sertraline (Zoloft), paroxetine (Paxil) and fluoxamine (Luvox). They also take between two and six weeks to show some benefits, and while they are usually (but not always} as effective as the older drugs, they tend to have fewer or at least more tolerable side effects. This makes them ideal for many older people. If you take one of these drugs, you may experience some nausea, headaches or agitation, but such side effects may disappear. Even so, they should always be reported to your doctor.

Finding the right dosage is extremely important. If the dose is too low, the drug won't be effective; if it's too high, you may experience unpleasant side effects. Recent studies have shown that older people can )obtain relief with lower doses of antidepressant medication, so your doctor may adopt a "start low, go slow" approach. Because antidepressants start to work only when they reach what doctors call a "therapeutic level" in your body, it's vital that you give these drugs enough time to work. This can be difficult if you're experiencing side effects, but most doctors recommend that you try each medication for at least four weeks before giving up and switching to a different drug.

Most people have to remain on antidepressant medication for many months, even after they begin to feel better. How long you continue to take the drug depends on your general health, the severity of the depression and whether your depressions tend to recur. You should never stop taking antidepressants suddenly, since this can cause problems. Instead, your doctor will advise you to taper the dosage down gradually. If your symptoms recur, you may have to take antidepressant drugs indefinitely.

Tricyclic Antidepressants

Tricyclic antidepressants are a type of antidepressant that has been used since the mid 1900s. Today, there are more than 30 different types of tricyclic antidepressants that are commonly used in cases of attention-deficit hyperactive disorder (ADHD) and depression. The antidepressant works by changing the way that certain neurotransmitters function in the brain in order to alter a person's mood. Many depression cases have been successfully treated while using tricyclic antidepressants, but this does not mean it is the right for everyone. There are other types of antidepressants a patient can try if this type isn't right for them.

As is true with most medications, different people can often react differently to the same medication. There are a number of symptoms that a patient can experience while taking this medications, though many will typically suffer only one or two of these symptoms if they experience any at all. It is having too many of these symptoms that can signify that this type of antidepressant may not be for the patient and it might be a good idea to try something else. It is extremely important that the patient taking a form of tricyclic antidepressant tell their therapist or counselor immediately if they are experiencing any of the following symptoms: drowsiness, hallucinations, nausea, vomiting, dry mouth and seizures. Any other possible symptoms a patient might start suffering other than the above mentioned should also be discussed with the doctor. When the doctor is aware of what affect the medication is having on the patient, they can alter the dose or medication accordingly so that the patient is treated effectively. For those who the medication works well for, it can be quite effective in altering the chemicals in the brain in such a way that the person's mood is changed for the better and they become more open to treatment.

Tricyclic antidepressants are simply a tool used to help the patient through their therapy. They are not meant as a permanent fix to the patient's depression. Instead, the antidepressants help the patient to calm down and/or open up about what might be putting them into their depression. To find out more about this type of antidepressant, an individual can contact an online therapist or counselor who would be more than happy to answer any questions the person may have. The online therapist can help the individual to understand what this type of antidepressant can do to help relieve their depression, and can also provide any therapy or counseling the person may need. In fact, online therapy is becoming a more popular resource all the time because it can be accessed from the comfort of one's home. The long and possibly uncomfortable wait in the waiting room is gone, and there is no need for the patient to have to take a significant amount of time out of their day to go see a therapist in person; instead, they can arrange a time to contact the therapist online from their home or office and get the answers and help they require.