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Dr. Bob is Robert Hsiung, MD,
bob@dr-bob.orgShown: posts 1 to 6 of 6. This is the beginning of the thread.
Posted by Mtom on August 10, 2021, at 17:20:58
In a separate thread , the discussion evolved into comparing TCAs (Tricyclics) vs new Antidepressants. It was discussed that there is published evidence that TCAs appear to be more effective. http://www.dr-bob.org/babble/20210723/msgs/1116258.html
However Ive found an interesting paper from 2011: https://www.nature.com/articles/npp2011306 Randomized, Placebo-Controlled Trials of Antidepressants for Acute Major Depression: Thirty-Year Meta-Analytic Review.
It did find TCAs more effective in trials reviewed. HOWEVER, they devote much of the paper to the observation that placebo response rates have been increasing over the years and note that older trials yielded consistently greater drugplacebo differences. Most TCA studies were done many years ago. They note that Antidepressant trials carried out before 1998 yielded higher values of all efficacy measures. Further analysis of the data for all trials supported the impression that apparent difference in response rates with the two classes of antidepressants (Tricyclics versus newer ADs) was accounted for by these changes in placebo responses. Responder RR values also declined significantly as the number of subjects and sites per trial increased. Trial duration also increased significantly across the years and longer-trials resulted in larger placebo responses. The increase in larger, more complex trials, carried out in varied geographic locations may also tend to impact the reliability of findings. They discuss other factors.
In the end they conclude that although older antidepressants TCAs showed somewhat superior efficacy to some second-generation antidepressants, these differences appear to have been influenced by changes in the nature of trials over the 30 years studied (note this paper was published in 2011).
It should be noted that another paper published in 2017 debates this conclusion (although I could only find access to the Abstract so havent read details): Has the rising placebo response impacted antidepressant clinical trial outcome? Data from the US Food and Drug Administration 1987‐2013. https://pubmed.ncbi.nlm.nih.gov/28498591/
Otherwise, I have not been able to find much in the way of trials with Tricyclics for depression prior to the early 2000s, most much prior to this.
If anyone knows of any more recent studies comparing efficacy to Tricyclics to newer antidepressants, I am very interested. Also personal experiences (positive and negative).
An additional concern to adverse effects previously discussed are more recent papers that anticholinergic meds including TCAs (and some other ADs) are associated with higher risk of developing cognitive impairment/dementia
Posted by SLS on August 11, 2021, at 12:12:27
In reply to So, are TCAs more effective than others, or not?, posted by Mtom on August 10, 2021, at 17:20:58
Trust older human clinical trials. They used stricter criteria to diagnose Major Depressive Disorder accurately and excluded people who didn't meet them.
The problem with more recent trials is that they let just about anyone in who says that they are depressed. That's why "placebo" rates are higher now. They are treating people with a drug not meant to be studied in people who don't have the disease they are investigating. Does psychogenic depression respond to antidepressants with equal efficacy compared to biogenic depression? What about the so-called minor depressions? For some people, just being in treatment for the first time and having psychological support from doctors and their staff creates optimism and a reduction in their reporting of depression severity - this is reported as a placebo effect. This is less likely to happen with a severe case of Major Depressive Disorder, especially with the endogenous / melancholic type.
- Scott
Posted by linkadge on August 12, 2021, at 9:12:38
In reply to So, are TCAs more effective than others, or not?, posted by Mtom on August 10, 2021, at 17:20:58
The data on this is lacking.
My hunch is that TCAs are likely more effective for certain forms of depression. Also, they may be more effective for severe depression.
This being said, individual differences can shape which drug an individual might respond to. So whether a class is better or worse overall, has little bearing on whether any given individual might respond.
Your doctor should not need data on this in order to do a trial of a TCA, if other drugs have not worked sufficiently.
Linkadge
Posted by alexandra_k on August 12, 2021, at 14:33:01
In reply to Re: So, are TCAs more effective than others, or not?, posted by linkadge on August 12, 2021, at 9:12:38
manufacturing varies more widely, too, now, with respect to the medication that is being produced. there may be genuinely less of a difference between medication and placebo given the amount of impurities etc present in less stringently produced manufacturing and quality control processes.
Posted by rjlockhart37 on August 12, 2021, at 16:20:50
In reply to Re: So, are TCAs more effective than others, or not?, posted by alexandra_k on August 12, 2021, at 14:33:01
i've read that TCAs are better for guys, and SSRI's work bettter with women. I don't know where i read that, but that's it
Posted by SLS on August 16, 2021, at 10:49:50
In reply to Re: So, are TCAs more effective than others, or not?, posted by rjlockhart37 on August 12, 2021, at 16:20:50
> i've read that TCAs are better for guys, and SSRI's work bettter with women. I don't know where i read that, but that's it
Yes.
- Scott
This is the end of the thread.
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