Articole MedLinx Iulie 2011


MDLinx  Internal Medicine

Your Article Summary

Sertraline or mirtazapine for depression in dementia (HTA-SADD): A randomised, multicentre, double-blind, placebo-controlled trial
The Lancet - Early Online Publication, 07/22/11
Banerjee S et al. ?Depression is common in dementia but the evidence base for appropriate drug treatment is sparse and equivocal. The authors aimed to assess efficacy and safety of two of the most commonly prescribed drugs, sertraline and mirtazapine, compared with placebo. Because of the absence of benefit compared with placebo and increased risk of adverse events, the present practice of use of these antidepressants, with usual care, for first-line treatment of depression in Alzheimer's disease should be reconsidered. Methods
  • We undertook the parallel-group, double-blind, placebo-controlled, Health Technology Assessment Study of the Use of Antidepressants for Depression in Dementia (HTA-SADD) trial in participants from old-age psychiatry services in nine centres in England
  • Participants were eligible if they had probable or possible Alzheimer's disease, depression (lasting &ge4 weeks), and a Cornell scale for depression in dementia (CSDD) score of 8 or more
  • Participants were ineligible if they were clinically critical (eg, suicide risk), contraindicated to study drugs, on antidepressants, in another trial, or had no carer
  • Clinical trials unit at King's College London (UK) randomly allocated participants with computer-generated block randomisation sequence, stratified by centre, with varying block sizes, in a 1:1:1 ratio to receive sertraline (target dose 150 mg per day), mirtazapine (45 mg), or placebo (control group), all with standard care
  • Primary outcome reduction in depression (CSDD score) at 13 weeks (outcomes to 39 weeks were also assessed), assessed with mixed linear-regression model adjusted for baseline CSDD, time, and treatment centre
Results
  • Decreases in depression scores at 13 weeks did not differ between 111 controls and 107 participants allocated to receive sertraline (mean difference 1?17, 95% CI -0?23 to 2?58; p=0?10) or mirtazapine (0?01, -1?37 to 1?38; p=0?99), or between participants in mirtazapine and sertraline groups (1?16, -0?25 to 2?57; p=0?11); these findings persisted to 39 weeks
  • Fewer controls had AE (29 of 111 [26%]) than did participants in sertraline group (46 of 107, 43%; p=0?010) or mirtazapine group (44 of 108, 41%; p=0?031), and fewer serious AE rated as severe (p=0?003)
  • 5 patients in every group died by week 39


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Other articles in Internal Medicine

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Dementia anxiety among older adult caregivers: an exploratory study of older adult caregivers in Canada
International Psychogeriatrics, 07/07/11

The Collateral Source version of the Geriatric Depression Scale: evaluation of psychometric properties and discrepancy between collateral sources and patients with dementia in reporting depression
International Psychogeriatrics, 07/07/11

Sertraline Induced Hepatotoxicity: A Case Report and Review of Literature
The Internet Journal of Gastroenterology, 06/30/11

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Your Article Summary

Vilazodone: In Major Depressive Disorder
CNS Drugs, 06/29/11
Frampton JE – Vilazodone was generally well tolerated in the short– and long–term treatment of major depressive disorder (MDD), with diarrhoea and nausea being the most frequently occurring treatment–emergent adverse events. Vilazodone had a minimal impact on sexual functioning in the three phase III studies.
  • Vilazodone, a novel antidepressant agent that combines selective serotonin reuptake inhibitor (SSRI) activity and serotonin 5–HT1A receptor partial agonist activity in a single molecule, is indicated for the treatment of major depressive disorder (MDD) in the US.
  • It is administered orally, once daily, with food.
  • At the recommended dosage of 40 mg/day, vilazodone was effective in the short–term treatment of MDD in adults, as evidenced by significant improvements versus placebo on multiple measures of depression, including the Montgomery–?sberg Depression Rating Scale (MADRS) and the 17–item Hamilton Rating Scale for Depression (HAM–D–17), in two pivotal, 8–week, randomized, double–blind, phase III studies.
  • Significant differences between vilazodone and placebo on the MADRS and HAM–D–17 were seen after 1 week of treatment (first efficacy timepoint) in one of the two studies.
  • Long–term treatment with vilazodone 40 mg/day was associated with an improvement from baseline in depressive symptoms in a 52–week, noncompar–ative, phase III study.


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Other articles in Internal Medicine

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Depressive Symptoms, Health Behaviors, and Subsequent Inflammation in Patients With Coronary Heart Disease: Prospective Findings From the Heart and Soul Study
American Journal of Psychiatry, 07/13/11

Association between depression and inflammation?differences by race and sex: The meta-health study
Psychosomatic Medicine, 07/08/11

Association between depression and inflammation?differences by race and sex: The META-Health Study
Psychosomatic Medicine, 07/05/11

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