BJP-2000-BECH-421-8

180 to 0104 correspondence dr p bech psychiatric

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Unformatted text preview: G. D. TOLLEFSON, PhD, Psychopharmacology Clinical Research, Eli Lilly and Co, Indianapolis, Indiana,USA Indiana, USA TCAbetter TCA better Effect size analysis for the actual change non-USA trials, as the old TCAs were used in 65% of the USA trials compared with 47% of the non-USA trials. from baseline to end-point on the 17 item Hamilton Depression Rating Scale scale in 11 USA trials v. tricyclic antidepressant (TCA) and 13 non-USA trials v. TCA (all randomised patients analysed, using a last observation carried forward technique).The horizontal lines represent the result for each trial and the global estimate is given at the bottom of the graph. imipramine and amitriptyline) separately from the `newer' TCAs (e.g. dothiepin, nortriptyline, clomipramine and doxepin). They found that the lower rate of discontinuation in patients on SSRIs was observed in the comparison with the old TCAs. This may explain our finding concerning the intention-to-treat analysis in the USA v. Comparison with other meta-analyses with fluoxetine In previous meta-analyses the effect size was mainly used, for example, Song et al (1993), Greenberg et al (1994) or Anderson & Tomenson (1994). Our results for fluoxetine v. placebo are in agreement with Greenberg et al (1994), although our effect size of 70.30 for the HDRS±17 remission outcome is low. In the Greenberg et al (1994) analysis we have detected some publication bias (i.e. unpublished trials not included) and double publication (i.e. data included from two publications of the same trial). When using the core symptoms of depression, the HDRS±6 outcome, we showed an effect size of 70.37, indicating that fluoxetine has an effect on the specific symptoms for major depression. This is in agreement with the results from our previous meta-analyses on citalopram and fluvoxamine (Bech, 1989; Bech & Cialdella, 1992). Our results for fluoxetine v. TCAs are in agreement with those published by Anderson & Tomenson (1994), that is, there is no difference in the antidepressive...
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