CONCLUSIONS This systematic review provides evidence for the efficacy of both SSRIs and TCAs in the treatment of chronic depression and showed a better acceptability of SSRIs
INTRODUCTION Chronic depression represents a substantial portion of depressive disorders and is associated with severe consequences .
This review examined the efficacy and acceptability of selective serotonin reuptake inhibitors ( SSRIs ) and tricyclic antidepressants ( TCAs ) in the treatment of chronic depression .
Additionally , the comparative effectiveness of the two types of antidepressants has been examined .
Escitalopram versus placebo in the treatment of dysthymic disorder
Numerous studies have assessed the acute efficacy of antidepressants , including selective serotonin reuptake inhibitors , in treating dysthymic disorder ; however , escitalopram , the S-enantiomer of citalopram , has not been studied . Thirty-six out patients with Structured Clinical Interview for DSM-III-R-diagnosed dysthymic disorder , aged 23–65 years ( mean±SD=44.7±11 years ) , were r and omly assigned to double-blind escitalopram ( maximum dose 20 mg/day ) versus placebo for 12 weeks . Inclusion criteria included age 18–65 years and Hamilton Depression Rating Scale ( HDRS ) score ≥12 . We hypothesized that escitalopram would be superior to placebo in the HDRS-24 item total score at week 12 . We also hypothesized the superiority of escitalopram over placebo for secondary measures , including the percentage of participants classified as responders and remitters , as well as social functioning ( Social Adjustment Scale ) , clinical global impression-improvement , Global Assessment of Functioning Scale . Participants ' baseline HDRS-24 averaged 23.4±5.9 . Final HDRS-24 scores at last observation carried forward did not differ significantly between escitalopram-treated  ( mean±SD=10.88±5.83 ) and placebo-treated  individuals ( mean±SD=16.4±6.34 ) ( F=2.82 , degrees of freedom=1,32 , P=0.10 ) . Significant differences favoring active medication were found on the Social Adjustment Scale and the Clinical Global Impression Severity and Global Assessment of Functioning Scale , but not in the percentages of responders or remitters . A larger study sample or higher escitalopram dose may show more significant placebo – medication differences
CONCLUSIONS This systematic review provides evidence for the efficacy of both SSRIs and TCAs in the treatment of chronic depression and showed a better acceptability of SSRIs
INTRODUCTION Chronic depression represents a substantial portion of depressive disorders and is associated with severe consequences .
This review examined the efficacy and acceptability of selective serotonin reuptake inhibitors ( SSRIs ) and tricyclic antidepressants ( TCAs ) in the treatment of chronic depression .
Additionally , the comparative effectiveness of the two types of antidepressants has been examined .