BACKGROUND: Antidepressant prescribing is widespread. Nonetheless, response to antidepressants is variable. If it was possible to predict response to medication and thus tailor treatment accordingly, this would not only improve patient outcomes but may also have economic benefits. AIMS: To test the hypothesis that individuals with more severe depression would benefit more from noradrenaline reuptake inhibitors (NARIs) than selective serotonin reuptake inhibitors (SSRIs) compared with individuals with less severe depression. METHOD: Individuals recruited from UK primary care who met ICD-10criteria for a depressive episode and scored 15 or more on the Beck Depression Inventory (BDI) were randomised to either an SSRI (citalopram 20 mg daily) or a NARI (reboxetine 4 mg twice daily). Randomisation was by means of a remote automated telephone system. The main outcome was depressive symptoms measured by the BDI total score 6 weeks after randomisation. ( TRIAL REGISTRATION: ISRCTN31345163.) RESULTS: In total, 601 participants were randomised (citalopram: n = 298, reboxetine: n = 303). Ninety-one per cent were followed up at 6 weeks (citalopram: n = 274, reboxetine: n = 272). There was little evidence to support an interaction between treatment and severity of depression (interaction term: 0.02, 95% CI -0.59 to 0.62, P = 0.96). Adjustment for potential confounders (age, gender, employment status, history of depression, number of life events and social support) did not affect the findings (interaction term: 0.06, 95% CI -0.54 to 0.66, P = 0.85). CONCLUSIONS: Treatment with NARIs does not confer any advantage over SSRI treatment for outcome in those with more severe depressive illness presenting in primary care.
RCT Entities:
BACKGROUND: Antidepressant prescribing is widespread. Nonetheless, response to antidepressants is variable. If it was possible to predict response to medication and thus tailor treatment accordingly, this would not only improve patient outcomes but may also have economic benefits. AIMS: To test the hypothesis that individuals with more severe depression would benefit more from noradrenaline reuptake inhibitors (NARIs) than selective serotonin reuptake inhibitors (SSRIs) compared with individuals with less severe depression. METHOD: Individuals recruited from UK primary care who met ICD-10 criteria for a depressive episode and scored 15 or more on the Beck Depression Inventory (BDI) were randomised to either an SSRI (citalopram 20 mg daily) or a NARI (reboxetine 4 mg twice daily). Randomisation was by means of a remote automated telephone system. The main outcome was depressive symptoms measured by the BDI total score 6 weeks after randomisation. ( TRIAL REGISTRATION: ISRCTN31345163.) RESULTS: In total, 601 participants were randomised (citalopram: n = 298, reboxetine: n = 303). Ninety-one per cent were followed up at 6 weeks (citalopram: n = 274, reboxetine: n = 272). There was little evidence to support an interaction between treatment and severity of depression (interaction term: 0.02, 95% CI -0.59 to 0.62, P = 0.96). Adjustment for potential confounders (age, gender, employment status, history of depression, number of life events and social support) did not affect the findings (interaction term: 0.06, 95% CI -0.54 to 0.66, P = 0.85). CONCLUSIONS: Treatment with NARIs does not confer any advantage over SSRI treatment for outcome in those with more severe depressive illness presenting in primary care.
Authors: Zheng Ye; Charlotte L Rae; Cristina Nombela; Timothy Ham; Timothy Rittman; Peter Simon Jones; Patricia Vázquez Rodríguez; Ian Coyle-Gilchrist; Ralf Regenthal; Ellemarije Altena; Charlotte R Housden; Helen Maxwell; Barbara J Sahakian; Roger A Barker; Trevor W Robbins; James B Rowe Journal: Hum Brain Mapp Date: 2016-01-12 Impact factor: 5.038
Authors: Joshua E J Buckman; Rob Saunders; Ciaran O'Driscoll; Zachary D Cohen; Joshua Stott; Gareth Ambler; Simon Gilbody; Steven D Hollon; Tony Kendrick; Edward Watkins; Nicola Wiles; David Kessler; Nomsa Chari; Ian R White; Glyn Lewis; Stephen Pilling Journal: Acta Psychiatr Scand Date: 2021-02-16 Impact factor: 7.734
Authors: J E J Buckman; R Saunders; J Stott; L-L Arundell; C O'Driscoll; M R Davies; T C Eley; S D Hollon; T Kendrick; G Ambler; Z D Cohen; E Watkins; S Gilbody; N Wiles; D Kessler; D Richards; S Brabyn; E Littlewood; R J DeRubeis; G Lewis; S Pilling Journal: Epidemiol Psychiatr Sci Date: 2021-06-04 Impact factor: 6.892
Authors: Joshua E J Buckman; Rob Saunders; Zachary D Cohen; Phoebe Barnett; Katherine Clarke; Gareth Ambler; Robert J DeRubeis; Simon Gilbody; Steven D Hollon; Tony Kendrick; Edward Watkins; Nicola Wiles; David Kessler; David Richards; Deborah Sharp; Sally Brabyn; Elizabeth Littlewood; Chris Salisbury; Ian R White; Glyn Lewis; Stephen Pilling Journal: Psychol Med Date: 2021-04-14 Impact factor: 7.723
Authors: Andrew A Crawford; Sarah Lewis; David Nutt; Tim J Peters; Philip Cowen; Michael C O'Donovan; Nicola Wiles; Glyn Lewis Journal: Psychopharmacology (Berl) Date: 2014-02-13 Impact factor: 4.530
Authors: Emmanuelle Weiller; Catherine Weiss; Christopher P Watling; Christopher Edge; Mary Hobart; Hans Eriksson; Maurizio Fava Journal: Neuropsychiatr Dis Treat Date: 2017-12-29 Impact factor: 2.570