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Fluoxetine versus amitriptyline in the treatment of major depression with associated anxiety (anxious depression): a double-blind comparison
Abstract
Although common in clinical settings, major depressive disorder with associated anxious symptoms ('anxious depression') has not been well studied in antidepressant clinical trials. The aim of this study was to compare the effects of fluoxetine versus amitriptyline in this group of patients. After a single-blind placebo run-in period of 2 weeks, patients were treated on a double-blind basis with fluoxetine or amitriptyline for 8 weeks. Assessment instruments included: 21-item Hamilton Rating Scale for Depression, Hamilton Rating Scale for Anxiety, Clinical Global Impressions, Raskin Depression Scale and Covi Anxiety Scale. A total of 157 patients were randomized to either fluoxetine or amitriptyline. Fluoxetine was given at a fixed dose of 20 mg/day and amitriptyline was given in a range of 50-250 mg/day (mean of 138.1 mg/day). Fluoxetine was comparable to amitriptyline in all efficacy measures except the HAMD sleep factor. Unwanted effects were more frequent and more severe in the amitriptyline-treated patients. Fluoxetine was comparably efficacious to amitriptyline in the treatment of major depression with associated anxiety. Since fluoxetine was far better tolerated, it is a promising alternative for this frequent and disabling condition.
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Amitriptyline (50-250mg) was associated with better improvements in Hamilton Rating Scale for Depression (HAMD) sleep scores than fluoxetine (20mg) in patients with chronic pain, although daytime drowsiness was a significantly greater problem with amitriptyline.
“In a study of patients with chronic pain (Versiani et al., 1999), amitriptyline (50-250mg) was associated with better improvements in Hamilton Rating Scale for Depression (HAMD; (Hamilton, 1960)) sleep scores than fluoxetine (20mg), although daytime drowsiness was a significantly greater problem with amitriptyline.”
From Antidepressants and their effect on sleep (2005) · cites this paper as Versiani et al., 1999
Clinician ratings of sleep (via HAMDS) have improved with amitriptyline, clomipramine, imipramine, dothiepin and doxepin.
“Clinician ratings of sleep (via HAMDS) have improved with amitriptyline (Versiani et al., 1999), clomipramine (Lepine et al., 2000), imipramine (Rosenberg et al., 1994), dothiepin (Corne and Hall, 1989) and doxepin (Feighner et al., 1986).”
From Antidepressants and their effect on sleep (2005) · cites this paper as Versiani et al., 1999
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Antidepressants and their effect on sleep
Mayers, A. G., & Baldwin, D. S. (2005) · Human Psychopharmacology: Clinical and Experimental · doi:10.1002/hup.726 · Cited by 323
Arnold, L. M., Hess, E. V., Hudson, J. I., Welge, J. A., Berno, S. E., & Keck, P. E. (2002) · The American Journal of Medicine · doi:10.1016/s0002-9343(01)01089-0 · Cited by 261
Effect of comorbid anxiety on treatment response in bipolar depression
Tohen, M., Calabrese, J., Vieta, E., Bowden, C., Gonzalez-Pinto, A., Lin, D., Xu, W., & Corya, S. (2007) · Journal of Affective Disorders · doi:10.1016/j.jad.2007.03.014 · Cited by 84
Defining anxious depression: going beyond comorbidity
Silverstone, P. H., & von Studnitz, E. (2003) · The Canadian Journal of Psychiatry · doi:10.1177/070674370304801006 · Cited by 57
Pharmacologic Treatment of Dimensional Anxious Depression: A Review
Ionescu, D. F., Niciu, M. J., Richards, E. M., & Zarate, C. A. (2014) · The Primary Care Companion For CNS Disorders · doi:10.4088/pcc.13r01621 · Cited by 56
Metadata
- Authors
- Versiani, M., Ontiveros, A., Mazzotti, G., Ospina, J., D??vila, J., Mata, S., Pacheco, A., Plewes, J., Tamura, R., & Palacios, M.
- Affiliations
- Eli Lilly (United States) (US)
- Venue
- International Clinical Psychopharmacology
- Published
- 1999-11
- Volume
- 14
- Issue
- 6
- Pages
- 321-327
- ISSN
- 0268-1315 (ISSN-L)
- OpenAlex
- W2032838626
- Cited by
- 38
- References
- 0
- Citations by year
- 2022: 1 · 2018: 1 · 2016: 1 · 2014: 1 · 2013: 4
- FWCI
- 1.11
- Type
- journal article
- Language
- en
- Open access
- closed
- Locations
- International Clinical Psychopharmacology (publishedVersion)
- PubMed (publishedVersion)
- Topics
- Health Sciences › Medicine › Pharmacology (medical) › Treatment of Major Depression
- Social Sciences › Psychology › Experimental and Cognitive Psychology › Anxiety, Depression, Psychometrics, Treatment, Cognitive Processes
- Social Sciences › Psychology › Clinical Psychology › Psychological Treatments and Disorders
- Keywords
- fluoxetine, amitriptyline, anxious depression, major depressive disorder, antidepressant efficacy, drug tolerability, adverse effects, sleep disorders, selective serotonin reuptake inhibitors, tricyclic antidepressants
- MeSH terms
- Adult, Amitriptyline, Antidepressive Agents, Tricyclic, Anxiety Disorders, Depressive Disorder, Double-Blind Method, Female, Fluoxetine, Humans, Male, Psychiatric Status Rating Scales, Antidepressive Agents, Second-Generation
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