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Cited by 274Treatment of Major DepressionMental Health Treatment and AccessAnxiety, Depression, Psychometrics, Treatment, Cognitive Processes

Effectiveness of antidepressants: Meta-analysis of dose-effect relationships in randomised clinical trials

Bollini, Paola, Pampaliona, Sandro, Tibaldi, Giuseppe, Kupelnick, Bruce, Munizza, Carmine·1999·British Journal of Psychiatry
DOI 10.1192/bjp.174.4.297
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Abstract

BACKGROUND: Antidepressant drugs are usually prescribed at low doses, possibly to avoid adverse reactions. No comprehensive review has addressed the issue of dose, clinical response and tolerability in a quantitative way. AIMS: To determine whether high doses of antidepressants are more effective than low doses, and how safety is affected by dose. METHOD: Trials comparing two or more doses of the same antidepressant were located, and all antidepressants administered were converted to the equivalent dose of imipramine. Generalised estimating equations were used to analyse percentage improvement and adverse event rate according to dose level. RESULTS: Thirty-three studies were identified. The dose level 100-200 mg imipramine equivalents showed an average improvement of 53% by 'intention-to-treat'. Higher doses were not accompanied by increased efficacy, while lower doses showed reduction in efficacy. Adverse events significantly increased with dose. CONCLUSIONS: With a low dose of antidepressants, clinicians trade off a slightly reduced chance of improvement for a higher chance of avoiding adverse reactions.

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Crossref · 10.1192/bjp.174.4.297

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  • Data on the effectiveness of antidepressants for depression show that overall only about 50% of patients randomised to active treatment were considered improved using intention-to-treat analyses at post-test.

    “However, this accords with data on the effectiveness of antidepressants for depression, where overall only about 50% of patients randomised to active treatment were considered improved using intention to treat analyses at post test [50].”

    From Internet-Based CBT for Depression with and without Telephone Tracking in a National Helpline: Randomised Controlled Trial (2011) · cites this paper as [50]

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Authors
Bollini, P., Pampaliona, S., Tibaldi, G., Kupelnick, B., & Munizza, C.
Affiliations
University of Turin (IT)
Corresponding author
Bollini, Paola
ORCID
Tibaldi, Giuseppe
Venue
British Journal of Psychiatry
Publisher
Royal College of Psychiatrists
Published
1999-04
Volume
174
Issue
4
Pages
297-303
ISSN
  • 0007-1250 (ISSN-L)
  • 1472-1465
DOI
10.1192/bjp.174.4.297
OpenAlex
W2049129528
Cited by
274
References
41
Citations by year
2026: 7 · 2025: 4 · 2024: 8 · 2023: 4 · 2022: 8 · 2021: 10 · 2020: 10 · 2019: 6 · 2018: 7 · 2017: 13 · 2016: 15 · 2015: 9 · 2014: 21 · 2013: 10 · 2012: 15
FWCI
1.40
Type
journal article
Language
en
Open access
closed
Licence
www.cambridge.org/core/terms (unspecified, 6851 d)
Locations
  • The British Journal of Psychiatry (publishedVersion)
  • PubMed (publishedVersion)
Topics
  • Health Sciences › Medicine › Pharmacology › Treatment of Major Depression
  • Social Sciences › Psychology › Social Psychology › Mental Health Treatment and Access
  • Social Sciences › Psychology › Experimental and Cognitive Psychology › Anxiety, Depression, Psychometrics, Treatment, Cognitive Processes
Keywords
antidepressants, dose-response relationship, antidepressant efficacy, drug tolerability, adverse drug reactions, low-dose antidepressants, depression treatment
MeSH terms
Age Factors, Antidepressive Agents, Depressive Disorder, Dose-Response Relationship, Drug, Humans, Randomized Controlled Trials as Topic, Treatment Outcome

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