Article

Relative antidepressant efficacy of bupropion and the selective serotonin reuptake inhibitors in major depressive disorder: gender-age interactions.

Department of Psychiatry, Massachusetts General Hospital, Harvard Medical School, Boston, Massachusetts 02114, USA.
International Clinical Psychopharmacology (Impact Factor: 3.1). 08/2007; 22(4):226-9. DOI: 10.1097/YIC.0b013e32819f8400
Source: PubMed

ABSTRACT To determine whether age/gender-based differences in efficacy exist between bupropion and the selective serotonin reuptake inhibitors for major depressive disorder, we pooled the findings of 10 double-blind studies comparing bupropion with a selective serotonin reuptake inhibitor. Men (N=943) and women (N=1179) were divided into three age groups (younger than 40, 40-55, older than 55). Improvement in terms of the 17-item Hamilton Depression Rating Scale, as well as the Bech melancholia, anxiety-somatization, and insomnia factors of the Hamilton Depression Rating Scale was compared between the two treatment groups. Of 64 pair-wise comparisons, only one was statistically significant. Specifically, more women treated with a selective serotonin reuptake inhibitor experienced a 50% or greater decrease in Hamilton Depression Rating Scale Anxiety-Somatization scores (58.8 versus 63.8%, P=0.0394). No difference, however, was seen in the degree of resolution of Hamilton Depression Rating Scale Anxiety-Somatization scores (continuous measure) between women treated with bupropion versus a selective serotonin reuptake inhibitor (P=0.114). Bupropion and the selective serotonin reuptake inhibitors, thus, appear to be equally effective in treating depressive symptoms, as well as anxious/somatic symptoms and insomnia in depression. No gender-related or age-related differences were found except that greater improvement was seen in anxious/somatic symptoms of depression among women during selective serotonin reuptake inhibitor treatment. This finding could, however, not be replicated when improvement in anxious/somatic symptoms was defined as a continuous measure.

0 Bookmarks
 · 
67 Views
  • [Show abstract] [Hide abstract]
    ABSTRACT: Pooled-studies publications (PSPs) present statistical analyses of multiple randomized controlled trials without a systematic literature search or critical appraisal. We explored the characteristics of PSPs and their potential impact on a systematic review (SR). We systematically evaluated PSPs excluded from an SR of second-generation antidepressants. We analyzed their basic characteristics, risk of bias, and the effect of new data on review conclusions. We identified 57 PSPs containing a median of five trials (range, 2-11) and 1,233 patients (range, 117-2,919). Ninety-six percent of PSPs were industry funded, and 49% of PSPs contained unpublished data. The median number of citations for PSPs was 29 (range, 0-549). Only 7% planned pooling a priori, and 19% combined trials with identical protocols. Fifty-nine percent of PSPs eligible for general efficacy provided no new data. For some subgroups and accompanying symptoms (e.g., anxiety, insomnia, melancholia, fatigue, sex, and race), more than 30% of PSPs presented entirely new data or data that could alter the strength of the evidence available in the SR. In this case study, PSPs provided new information on subgroups and secondary outcomes; however, guidance for reviewers and development of a system to assess their susceptibility to bias are required.
    Journal of clinical epidemiology 07/2013; · 5.48 Impact Factor
  • [Show abstract] [Hide abstract]
    ABSTRACT: The objective of the current study is to investigate the role of the nicotinic receptor β4 subunit in the antidepressant activity of bupropion. Wild-type (β4+/+) and knockout (β4-/-) mice were intraperitoneally administered with normal saline (control) or bupropion (40mg/kg) daily for the first two weeks. Forced swim tests were performed on Day 1 to determine the acute effect of bupropion at 0, 15, 30, 45, or 60min after the injection, and after two weeks of daily treatment to determine the chronic effects. To examine the remnant effects of bupropion after withdrawal, forced swim tests were performed one and two weeks after the last day of treatment with bupropion. Our results indicate that: (1) the acute treatment with bupropion increases the swimming time (i.e., antidepressant effect) in β4+/+ and β4-/- mice from both genders, (2) the antidepressant effect after the chronic treatment is seen only in female β4+/+ mice, and (3) the residual antidepressant effect of bupropion persists only in male β4+/+ mice after one week withdrawal. We conclude that the β4 subunit plays a modulatory role in the chronic antidepressant effect mediated by bupropion, and that its effect is gender-specific.
    Neuroscience Letters 08/2013; · 2.06 Impact Factor
  • [Show abstract] [Hide abstract]
    ABSTRACT: Women are twice as likely to develop depression as men. Moreover, the symptoms they experience also show sex differences: women tend to develop depression at an earlier age and show more severe symptoms than men. Likewise, the response to antidepressant pharmacotherapy appears to have sex differences. These differences can partially be explained by differences in pharmacokinetic properties (i.e., absorption, distribution, metabolism, and excretion) of drugs in males and females. More recent research has shown that sex hormones may influence all these previously named pharmacokinetic processes. As concentrations of sex hormones vary throughout the female lifespan, these hormonal variations can have effects on therapeutic responses to antidepressants as well as the occurrence of adverse events. The purpose of this paper is therefore to review the literature reporting on the effects of female sex hormones on the pharmacokinetics of antidepressants and to discuss and evaluate the implications of changes in levels of sex hormones throughout life for the treatment of depression.
    Clinical Pharmacokinetics 05/2014; 53(6). · 5.49 Impact Factor