Conclusions : International differences in prescriber behaviour may influence , and in turn be influenced by , the conduct of clinical trials .
Objective : International differences are thought to exist in dosages used by clinicians treating mood disorders .
This study examined international dosage differences in antidepressant clinical trials , using a data base formed and maintained as a component of a Cochrane review of comparative clinical trials of fluoxetine .
Comparative effects of nefazodone and fluoxetine on sleep in outpatients with major depressive disorder
BACKGROUND Sleep disturbances are common in major depressive disorder . In previous open-label trials , nefazodone improved sleep continuity and increased rapid eye movement ( REM ) sleep , while not affecting stage 3/4 sleep or REM latency : in contrast , fluoxetine suppressed REM sleep . This study compared the objective and subjective effects of nefazodone and fluoxetine on sleep . METHODS This paper reports combined results of three identical , multisite , r and omized , double-blind , 8-week , acute-phase trials comparing  nefazodone ( n = 64 ) with fluoxetine ( n = 61 ) in out patients with nonpsychotic major depressive disorder and insomnia . Sleep  electroencephalographic  ( EEG ) recordings were gathered at baseline and weeks 2 , 4 , and 8 . Clinical ratings were obtained at weeks 1 - 4 , 6 , and 8 . RESULTS Nefazodone and fluoxetine were equally effective in reducing depressive symptoms ; however , nefazodone differentially and progressively increased ( while fluoxetine reduced ) sleep efficiency and reduced ( while fluoxetine increased ) the number of awakenings in a linear fashion over the 8-week trial . Fluoxetine , but not nefazodone , prolonged REM latency and suppressed REM sleep .  Nefazodone significantly increased total REM sleep time . Clinical evaluations of sleep quality were significantly improved with nefazodone compared with fluoxetine . CONCLUSIONS Nefazodone and fluoxetine were equally effective antidepressants . Nefazodone was associated with normal objective , and clinician- and patient-rated assessment s of sleep when compared with fluoxetine . These differential sleep EEG effects are consistent with the notion that nefazodone and fluoxetine may have somewhat different modes and spectra of action
Conclusions : International differences in prescriber behaviour may influence , and in turn be influenced by , the conduct of clinical trials .
Objective : International differences are thought to exist in dosages used by clinicians treating mood disorders .
This study examined international dosage differences in antidepressant clinical trials , using a data base formed and maintained as a component of a Cochrane review of comparative clinical trials of fluoxetine .