Evidence from meta- analysis of r and omised controlled trials ( RCTs ) and r and omised pragmatic trials was found in support of greater efficacy of the serotonin noradrenaline reuptake inhibitors ( SNRIs ) , venlafaxine and duloxetine , in moderate to severe depression compared to SSRIs but no evidence was found for superiority of milnacipran .
There is sufficient current evidence that demonstrates an increase in efficacy , when noradrenaline reuptake is added to serotonin ( 5-HT ) reuptake , to suggest that patients with severe depression or those who have failed to reach remission with a SSRI may benefit from treatment with a SNRI .
Selective serotonin reuptake inhibitors ( SSRIs ) are recommended as first-line pharmacological treatment for depression and are the most commonly prescribed class of antidepressants .
However , there is substantial evidence that noradrenaline has a role in the pathogenesis and treatment of depression .
This review aims to examine the evidence of including noradrenaline reuptake inhibition with serotonin reuptake inhibition with respect to increasing efficacy in the treatment of depression .
Handling drop-out in longitudinal clinical trials: a comparison of the LOCF and MMRM approaches.
This study compares two methods for h and ling missing data in longitudinal trials : one using the last-observation-carried-forward ( LOCF ) method and one based on a multivariate or mixed model for repeated measurements ( MMRM ) . Using data sets simulated to match six actual trials , I imposed several drop-out mechanisms , and compared the methods in terms of bias in the treatment difference and power of the treatment comparison . With equal drop-out in Active and Placebo arms , LOCF generally underestimated the treatment effect ; but with unequal drop-out , bias could be much larger and in either direction . In contrast , bias with the MMRM method was much smaller ; and whereas MMRM rarely caused a difference in power of greater than 20 % , LOCF caused a difference in power of greater than 20 % in nearly half the simulations . Use of the LOCF method is therefore likely to misrepresent the results of a trial seriously , and so is not a good choice for primary analysis . In contrast , the MMRM method is unlikely to result in serious misinterpretation , unless the drop-out mechanism is missing not at r and om ( MNAR ) and there is substantially unequal drop-out . Moreover , MMRM is clearly more reliable and better grounded statistically . Neither method is capable of dealing on its own with trials involving MNAR drop-out mechanisms , for which sensitivity analysis is needed using more complex methods
Evidence from meta- analysis of r and omised controlled trials ( RCTs ) and r and omised pragmatic trials was found in support of greater efficacy of the serotonin noradrenaline reuptake inhibitors ( SNRIs ) , venlafaxine and duloxetine , in moderate to severe depression compared to SSRIs but no evidence was found for superiority of milnacipran .
There is sufficient current evidence that demonstrates an increase in efficacy , when noradrenaline reuptake is added to serotonin ( 5-HT ) reuptake , to suggest that patients with severe depression or those who have failed to reach remission with a SSRI may benefit from treatment with a SNRI .
Selective serotonin reuptake inhibitors ( SSRIs ) are recommended as first-line pharmacological treatment for depression and are the most commonly prescribed class of antidepressants .
However , there is substantial evidence that noradrenaline has a role in the pathogenesis and treatment of depression .
This review aims to examine the evidence of including noradrenaline reuptake inhibition with serotonin reuptake inhibition with respect to increasing efficacy in the treatment of depression .