Amitriptyline is an efficacious antidepressant drug .
It is , however , also associated with a number of side effects .
Degree of placebo response and severity of depression at baseline may moderate drug-placebo efficacy differences
BACKGROUND Amitriptyline is a tricyclic antidepressant that was synthesis ed in 1960 and introduced as early as 1961 in the USA , but is still regularly used .
It has also been frequently used as an active comparator in trials on newer antidepressants and can therefore be called a ' benchmark ' antidepressant .
However , its efficacy and safety compared to placebo in the treatment of major depression has not been assessed in a systematic review and meta- analysis .
OBJECTIVES To assess the effects of amitriptyline compared to placebo or no treatment for major depressive disorder in adults .
Randomised controlled trial comparing problem solving treatment with amitriptyline and placebo for major depression in primary care
Abstract Objective : To determine whether , in the treatment of major depression in primary care , a brief psychological treatment ( problem solving ) was ( a ) as effective as antidepressant drugs and more effective than placebo ; ( b ) feasible in practice ; and ( c ) acceptable to patients . Design : R and omised controlled trial of problem solving treatment , amitriptyline plus st and ard clinical management , and drug placebo plus st and ard clinical management . Each treatment was delivered in six sessions over 12 weeks . Setting : Primary care in Oxfordshire . Subjects : 91 patients in primary care who had major depression . Main outcome measures : Observer and self reported measures of severity of depression , self reported measure of social outcome , and observer measure of psychological symptoms at six and 12 weeks ; self reported measure of patient satisfaction at 12 weeks . Numbers of patients recovered at six and 12 weeks . Results : At six and 12 weeks the difference in score on the Hamilton rating scale for depression between problem solving and placebo treatments was significant ( 5.3 ( 95 % confidence interval 1.6 to 9.0 ) and 4.7 ( 0.4 to 9.0 ) respectively ) , but the difference between problem solving and amitriptyline was not significant ( 1.8 ( −1.8 to 5.5 ) and 0.9 ( −3.3 to 5.2 ) respectively ) . At 12 weeks 60 % ( 18/30 ) of patients given problem solving treatment had recovered on the Hamilton scale compared with 52 % ( 16/31 ) given amitriptyline and 27 % ( 8/30 ) given placebo . Patients were satisfied with problem solving treatment ; all patients who completed treatment ( 28/30 ) rated the treatment as helpful or very helpful . The six sessions of problem solving treatment totalled a mean therapy time of 3 1/2 hours . Conclusions : As a treatment for major depression in primary care , problem solving treatment is effective , feasible , and acceptable to patients . Key messages Key messages Patient compliance with antidepressant treatment is often poor , so there is a need for a psychological treatment This study found that problem solving is an effective psychological treatment for major depression in primary care — as effective as amitriptyline and more effective than placebo Problem solving is a feasible treatment in primary care , being effective when given over six sessions by a general practitioner Problem solving treatment is acceptable to
Amitriptyline is an efficacious antidepressant drug .
It is , however , also associated with a number of side effects .
Degree of placebo response and severity of depression at baseline may moderate drug-placebo efficacy differences
BACKGROUND Amitriptyline is a tricyclic antidepressant that was synthesis ed in 1960 and introduced as early as 1961 in the USA , but is still regularly used .
It has also been frequently used as an active comparator in trials on newer antidepressants and can therefore be called a ' benchmark ' antidepressant .
However , its efficacy and safety compared to placebo in the treatment of major depression has not been assessed in a systematic review and meta- analysis .
OBJECTIVES To assess the effects of amitriptyline compared to placebo or no treatment for major depressive disorder in adults .