© 1999 Evidence-Based Mental Health
Review: lower doses of antidepressant drugs are effective and have fewer adverse effects in depression
Bollini P, Pampallona S, Tibaldi G, et al. Effectiveness of antidepressants. Meta-analysis of dose-effect relationships in randomised clinical trials. Br J Psychiatry 1999 Apr;174:297–303.
Questions In patients with depression, are high doses of antidepressants more effective then low doses, and how is safety affected?
Studies were identified by searching Medline, Current Contents, and the Cochrane Collaboration Register of Trials; scanning the bibliographies of retrieved articles; and contacting authors.
Studies were selected if they were randomised controlled trials comparing 2 different doses of the same antidepressant drug in patients with depression (>5 patients per treatment arm) who were followed up for at least 3 weeks.
Data were extracted on patient characteristics; type, dose, and duration of treatment; number of dropouts; type of concurrent medication or psychological treatment; number of patients clinically improved (defined as a reduction of >50% of the total score on the Hamilton Rating Scale for Depression, moderate to marked improvement on the Clinical Global Impression Scale, or lack of relapse of depressive episode); and total number of side effects. All antidepressants given were converted to the equivalent dose of imipramine. Generalised estimating equations were used to analyse percentage improvement and adverse event
Warneford Hospital, Oxford, UK
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