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Comparing onset of effect of antidepressants: Pragmatic considerations on methods and end-points

Published online by Cambridge University Press:  16 April 2020

D Hackett
D Hackett*
Affiliation:
Wyeth-Ayerst Research, European CR&D, Le Wilson II, 80 ave du Président Wilson, Puteaux, 92031 Paris La Défense Cedex, France
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Summary

There is no accepted definition of what constitutes onset of antidepressant effect, and this limits evaluation of the validity of many comparative reports. In order to clarify the nature of the comparative methodology required, it is proposed that two distinct research questions are separated conceptually: 1) when do antidepressant drugs begin to clinically act? and 2) do all antidepressant drugs produce relief of symptoms in patients within a similar time period? A methodological distinction may also be made in terms of whether to assess the onset of effect of an antidepressant as having an absolute quality (“fast”) or as being fast relative to other treatments (“faster”). The choice of aim will help to define the methodological approach, the applicability of the findings and the difficulties to be addressed. Describing an antidepressant as showing a “fast” or “faster” onset of response requires that any description attempts to define (in terms that may be generalised) the nature of the comparison (faster than what?), the nature of the effect (faster to do what?) and the population in whom this effect may be expected (faster in whom?). Some details of methodological approaches are reviewed, and suggestions for study designs are made.

Keywords

clinical-trial-methodologyantidepressantsonset-of-action

Information

Type
Research Article
Information
European Psychiatry , Volume 13 , Issue 3 , May 1998 , pp. 117 - 123
Copyright
Copyright © Elsevier, Paris 1998

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References

Amsterdam, JD, Case, WG, Csanalosi, E, Singer, M, Rickels, KA double blind comparative trial of zimelidine, amitriptyline, and placebo in patients with mixed anxiety and depression Pharmacopsychiatry 1986; 19: 115–119CrossRefGoogle ScholarPubMed
Angst, J, Delini Stula, A, Stabl, M, Stassen, HHIs a cut off score a suitable measure of treatment outcome in short term trials in depression? A methodological meta analysis Hum Psychopharmacol 1993; 8: 311–317CrossRefGoogle Scholar
Artigas, F, Romero, L, de Montigny, C, Blier, PAcceleration of the effect of selected antidepressant drugs in major depression by 5-HT1A antagonists Trends Neurosci 1996; 19: 378–383CrossRefGoogle ScholarPubMed
Benkert, O, Grunder, G, Wetzel, H, Hackett, DA randomized, double-blind comparison of a rapidly escalating dose of venlafaxine and imipramine in inpatients with major depression and melancholia JPsychiatr Res 1996; 30: 441–451CrossRefGoogle ScholarPubMed
Blier, P, Bergeron, R, de Montigny, CSelective activation of postsynaptic 5-HT1A receptors induces rapid antidepressant response Neuropsychopharmacology 1997; 16: 333–338CrossRefGoogle ScholarPubMed
Brink, CW, Dunbar, GC, Behagel, HAA controlled clinical trial of mianserin and placebo in the treatment of depression in general practice Tijdschr Ther Geneesm Onderz 1984; 9: 513–517Google Scholar
Carman, JS, Ahdieh, H, Wyatt, KE, Warga, E, Panagides, JA controlled study of mianserin in moderately to severely depressed outpatients Psychopharmacol Bull 1991; 27: 135–139Google ScholarPubMed
Cohn, JB, Wilcox, Paroxetine in major depression : a double blind trial with imipramine and placebo CS J Clin Psychiatry 1992 53 suppl 2 52–56Google ScholarPubMed
Derivan, A, Entsuah, AR, Kikta, DVenlafaxine: measuring the onset of antidepressant action Psychopharmacol Bull 1995; 31: 439–447Google ScholarPubMed
Dunbar, GC, Cohn, JB, Fabre, LF, Feighner, JP, Fieve, RR, et al.A comparison of paroxetine, imipramine and placebo in depressed outpatients Br J Psychiatry 1991; 159: 394–398CrossRefGoogle Scholar
Edwards, JG, Goldie, APlacebo controlled trial of mianserin and maprotiline in primary depressive illness: a preliminary report Br J Clin Pharmacol 1983 15 suppl 2 239S–248SCrossRefGoogle ScholarPubMed
Fabre, LF, Crismon, LEfficacy of fluoxetine in outpatients with major depression Ther Res Clin Exp 1985; 37: 115–123Google Scholar
Feighner, JP, Meredith, CH, Frost, NR, et al.A double blind comparison of alprazolam vs. imipramine and placebo in the treatment of major depressive disorder Acta Psychiatr Scand 1983; 68: 223–233CrossRefGoogle ScholarPubMed
Feighner, JP, Aden, GC, Fabre, LF, Rickels, K, Smith, WTComparison of alprazolam, imipramine, and placebo in the treatment of depression JAMA 1983; 249: 3057–3064CrossRefGoogle ScholarPubMed
Feighner, JP, Meredith, CH, Stern, WC, Hendrickson, G, Miller, LLA double blind study of bupropion and placebo in depression Am J Psychiatry 1984; 141: 525–529Google ScholarPubMed
Feighner, JPA review of controlled studies of adinazolam mesylate in patients with major depressive disorder Psychopharmacol Bull 1986; 22: 186–191Google ScholarPubMed
Feighner, JP, Boyer, PParoxetine in the treatment of depression: a comparison with imipramine and placebo WF J Clin Psychiatry 1992 53 suppl 2 44–47Google ScholarPubMed
Feighner, JP, Cohn, JB, Fabre, LFJ, Fieve, RR, Mendels, J, et al.A study comparing paroxetine placebo and imipramine in depressed patients J Affect Disord 28 1993 71–79CrossRefGoogle ScholarPubMed
Georgia, EHDouble blind comparison of the efficacy and safety of nomifensine maleate vs. placebo in depressed outpatients J Clin Psychiatry 1984; 45: 43–46Google ScholarPubMed
Gisselmann, AActivité et acceptabilité de l'indalpine en double aveugle contre placebo Encephale 1984; 10: 231–234Google Scholar
Guelfi, JD, White, C, Hackett, D, Guichoux, JY, Magni, GEffectiveness of venlafaxine in patients hospitalised for major depression and melancholia J Clin Psychiatry 1995; 56: 450–458Google Scholar
Hicks, F, Robins, E, Murphy, GEComparison of adinazolam, amitriptyline, and placebo in the treatment of melancholic depression Psychiatry Res 1988; 23: 221–227CrossRefGoogle ScholarPubMed
Jansen, W, Siegfried, KNomifensine in geriatric inpatients: a placebo controlled study J Clin Psychiatry 1984; 45: 63–67Google ScholarPubMed
Katz, MM, Koslow, SH, Maas, JW, et al.The timing, specificity and clinical prediction of tricyclic drug effects in depression Psychol Med 1987; 17: 297–309CrossRefGoogle ScholarPubMed
Katz, MM, Koslow, SH, Maas, JW, et al.Identifying the specific clinical actions of amitriptyline : interrelationships of behaviour, affect and plasma levels in depression Psychol Med 1991; 21: 599–611CrossRefGoogle ScholarPubMed
Katz, MM, Koslow, SH, Frazer, AOnset of antidepressant activity: re-examining the structure of depression and multiple actions of drugs Depress Anxiety 1997; 4: 257–2673.0.CO;2-9>CrossRefGoogle Scholar
Leber, PSpeed of onset Psychopharmacol Bull 1995; 31: 37–40Google ScholarPubMed
Merideth, CH, Feighner, JPThe use of bupropion in hospitalized depressed patients J Clin Psychiatry 1983; 44: 85–87Google ScholarPubMed
Miller, SM, Naylor, GJ, Murtagh, M, Winslow, A double blind comparison of paroxetine and placebo in the treatment of depressed patients in a psychiatric outpatient clinic Acta Psychiatr Scand 1989; 350: 143–144CrossRefGoogle Scholar
Montgomery, SAAre 2-week trials sufficient to indicate efficacy? Psychopharmacol Bull 1995; 31: 41–44Google ScholarPubMed
Perez, V, Gilaberte, I, Faries, D, Alvarez, E, Artigas, FRandomised, double-blind, placebo-controlled trial of pindolol in combination with fluoxetine antidepressant treatment Lancet 1997; 349: 1594–1597CrossRefGoogle ScholarPubMed
aPrien, RF, Blaine, JD, Levin, JAntidepressant drug therapy: the role of new antidepressants Hosp Community Psychiatry 1985; 36: 513–516Google ScholarPubMed
Pitts, WM, Fann, WE, Halaris, AE, et al.Bupropion in depression: a tri center placebo controlled study J Clin Psychiatry 1983; 44: 95–100Google ScholarPubMed
Quitkin, FM, McGrath, PJ, Rabkin, JG, et al.Different types of placebo response in patients receiving antidepressants Am J Psychiatry 1991; 148: 197–203Google ScholarPubMed
Quitkin, FM, Rabin, JG, Stewart, JW, et al.Heterogeneity of clinical response during placebo treatment Am J Psychiatry 1991; 148: 193–196Google ScholarPubMed
Quitkin, FM, Stewart, JW, McGrath, PJ, et al.Further evidence that a placebo response to antidepressants can be identified Am J Psychiatry 1993; 150: 566–570Google ScholarPubMed
Quitkin, FM, McGrath, PJ, Stewart, JW, Taylor, BP, Klein, DFCan the effects of antidepressants be observed in the first two weeks of treatment? Neuropsychopharmacol 1996; 15: 390–394CrossRefGoogle ScholarPubMed
Reimherr, FW, Chouinard, G, Cohn, CK, et al.Antidepressant efficacy of sertraline : a double blind, placebo and amitriptyline controlled, multicenter comparison study in outpatients with major depression J Clin Psychiatry 1990 51suppl 12 18–27Google ScholarPubMed
Rickels, K, Feighner, JP, Smith, WTAlprazolam, amitriptyline, doxepin, and placebo in the treatment of depression Arch Gen Psychiatry 1985; 42: 134–141CrossRefGoogle ScholarPubMed
Rickels, K, Chung, HR, Csanalosi, IB, et al.Alprazolam, diazepam, imipramine, and placebo in outpatients with major depression Arch Gen Psychiatry 1987; 44: 862–866CrossRefGoogle ScholarPubMed
Robinson, DS, Rickels, K, Feighner, J, et al.Clinical effects of the 5 HT(1A) partial agonists in depression : a composite analysis of buspirone in the treatment of depression J Clin Psychopharmacol 1990 10 suppl 3 67S–76SCrossRefGoogle Scholar
Stassen, HH, Delini-Stula, A, Angst, ATime course of improvement under antidepressant treatment : a survival-analytical approach Eur Neuropsychopharmacol 1993; 3: 127–135CrossRefGoogle ScholarPubMed
Stassen, HH, Angst, J, Delini-Stula, ASeverity at baseline and onset of improvement in depression. Meta analysis of imipramine and moclobemide versus placebo Eur Psychiatry 1994; 9: 129–136CrossRefGoogle Scholar
Weissman, MM, Prusoff, B, Sholomskas, AJ, Greenwald, SA double blind clinical trial of alprazolam, imipramine, or placebo in the depressed elderly J Clin Psychopharmacol 1992; 12: 175–182CrossRefGoogle ScholarPubMed
Wernicke, JF, Dunlop, SR, Domself, BE, Bosomworth, JC, Humbert, MLow-dose fluoxetine therapy for depression Psychopharmacology Bull 1988; 24: 183–188Google ScholarPubMed
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