A multicenter double-blind trial of paroxetine versus amitriptyline in depressed inpatients.
ABSTRACT The phenylpiperidine derivative paroxetine is a selective serotonin reuptake inhibitor. In a double-blind 6-week trial, paroxetine was compared with amitriptyline in hospitalized patients suffering from major depression (DSM-III). One hundred fifty-three patients were enrolled in the study in seven centers in Austria and Germany. Results showed similar efficacy of both drugs after 6 weeks. The differences between groups in Montgomery-Asberg Depression Rating Scale and Clinical Global Impression ratings did not reach statistical significance at any time. Side effects were distributed similarly but with a significantly higher incidence of anticholinergic effects in patients treated with amitriptyline (p < or = 0.001), whereas agitation and insomnia were registered more often in the paroxetine group. This study supports the antidepressive efficacy of paroxetine in a sample of severely depressed inpatients.
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ABSTRACT: Our results suggest that between 29% and 46% of depressed patients fail to respond fully with antidepressant treatment of adequate dose and duration. In particular, although partial response appears to occur in 12% to 15% of the depressed patients studied, nonresponse is observed in 19% to 34% of this population. The prevalence of treatment-resistant depression derived from studies using ITT analysis is likely to be an overestimate of the actual occurrence of the phenomenon, as these rates also reflect the outcome of patients who were treated inadequately or were intolerant to the treatment. On the other hand, data derived from studies using completer analysis are likely to generate under-estimates of the prevalence of this phenomenon, as patients may have dropped out before completion of the study due to lack of efficacy. One could, therefore, guess that the actual rates of treatment resistance in the clinical population of depressed patients probably lie between these two types of estimates. From an epidemiologic point of view, because the prevalence of depression has been estimated to vary from 2.6% to 5.5% in men and from 6.0% to 11.8% in women, one must conclude that treatment-resistant depression is a very common clinical problem that is likely to affect more than one third of depressed patients. In summary, treatment-resistant depression patients can be defined as those who fail to respond to standard doses (i.e., significantly superior to placebo in double-blind studies) of antidepressants administered continuously for at least 6 weeks. Additional requirements of this operational definition are an accurate diagnosis of depressive disorder, patient compliance with the treatment, the use of valid outcome measures, and therapeutic range of antidepressant blood levels for the tricyclic antidepressants. Finally, symptomatic improvement that is equal or greater than 25% and less than 50% qualifies as partial response, and less than 25% symptomatic improvement is complete nonresponse.Psychiatric Clinics of North America 07/1996; 19(2):179-200. DOI:10.1016/S0193-953X(05)70283-5 · 2.13 Impact Factor
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ABSTRACT: In this paper, a low-temperature high-pressure triaxial test system including pressure crystal device (sample preparation system) was developed, in which the conditions of hydrate stabilized can be maintained. To determine the stress strain behavior of methane hydrate, the triaxial shear tests were performed under the condition of strain rates of 1.5%/min, temperatures θ=−5, −10, and −20°C and confining pressures P=2.5, 5 and 10MPa. The preliminary results show that the stress strain curves can be divided into two stages: the rapid structural damage stage and the complete structural damage stage (or the yield stage). Based on the experimental and analysis results of stress strain behavior of triaxial tests, this paper proposes a modified nonlinear elastic Duncan–Chang constitutive model suitable for artificial methane hydrate. The modified model takes into account the effect of temperature and confining pressure as well as hydrate structure on the stress strain behavior. By comparing experimental with simulation results, the validity of model had been evaluated.Journal of Petroleum Science and Engineering 05/2011; 77(2):183-188. DOI:10.1016/j.petrol.2011.03.004 · 1.10 Impact Factor
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ABSTRACT: This multicenter study compared the efficacy and safety of citalopram and placebo in a population of moderately to severely depressed patients with melancholia. This randomized, double-blind, parallel-group study compared citalopram (flexible dose; 20–80 mg/day) with placebo in 180 psychiatric outpatients with a DSM-III diagnosis of major depression or bipolar disorder, depressed, who also met DSM-III criteria for melancholia. Following a 1-week placebo washout period, patients meeting study entry criteria were randomized to 4 weeks of double-blind treatment with either citalopram or placebo. Efficacy measures included the Hamilton Rating Scale for Depression (HAM-D), the Clinical Global Impressions (CGI) Scale, and the Zung Self-Rating Depression Scale. Patients treated with citalopram showed significantly greater improvement at endpoint than placebo patients on the HAM-D, CGI, and Zung scales. On the HAM-D, citalopram patients exhibited significantly greater improvement than placebo patients after 1 week of double-blind treatment and at all subsequent study visits. Endpoint analyses of the HAM-D subscales demonstrated that citalopram produced significant improvement of the psychomotor retardation, cognitive disturbance, sleep disturbance, and melancholia symptom clusters. Nausea, dry mouth, somnolence, dizziness, and increased sweating were reported at higher rates by citalopram-treated patients than by placebo-treated patients, but there were no significant citalopram-placebo differences in the incidence of activation (e.g., anxiety, nervousness, insomnia) or sexual dysfunction. Analysis of electrocardiograms, vital signs, and laboratory tests did not reveal any clinically significant effects of citalopram treatment. The results of this study indicate that citalopram is safe and effective in the treatment of depressed patients with melancholia, and is associated with a favorable side effect profile and a potentially rapid onset of action. Depression and Anxiety 9:54–60, 1999. © 1999 Wiley-Liss, Inc.Depression and Anxiety 01/1999; 9(2):54 - 60. DOI:10.1002/(SICI)1520-6394(1999)9:2<54::AID-DA2>3.0.CO;2-T · 4.29 Impact Factor