In a multicenter, placebo-controlled, clinical trial, the efficacy of Limbitrol was compared with that of its components, amitriptyline and chlordiazepoxide. All patients had a diagnosis of primary ...depression. Data from 279 patients were evaluated using the Hamilton depression scale, the Beck depression inventory, and physician and patient global change measures. Statistically significant differences favoring Limbitrol occurred after 1 week of treatment, and a trend in favor of Limbitrol continued throughout the remaining 3 weeks. In most efficacy comparisons, the combination was as good as, or better than, amitriptyline alone. It was superior to chlordiazepoxide alone after 2 and 4 weeks of treatment. Each component produced an independent contribution to the total therapeutic effect: the chlordiazepoxide effect was more prominent in the first 2 weeks and the amitriptyline effect in the latter 2 weeks. A trend favoring amitriptyline over chlordiazepoxide was evident by week 4. The overall incidence of side effects was comparable in both Limbitrol- and amitriptyline-treated groups. Limbitrol-treated patients exhibited more sedation, but significantly fewer Limbitrol patients discontinued treatment prematurely because of side effects.
Trazodone's unique chemical structure reflects its distinct pharmacologic profile. Its antidepressant efficacy is postulated to occur through serotonin reuptake inhibition. It has little effect on ...other neurotransmitter systems. In the United States it has been studied in several double-blind trials which compared it to standard antidepressants and placebo. Both in- and outpatients spanning a spectrum of age and diagnoses have been studied. Trazodone has been shown to be at least as effective as standard antidepressants. There are few anticholinergic or cardiovascular side effects. Adverse reactions include drowsiness, dizziness, headache, nausea and rarely, priapism. It is relatively safe in overdose. Trazodone deserves special consideration in the treatment of patients with depression accompanied by marked agitation, anxiety, and insomnia, as well as those unable to tolerate anticholinergic side effects.
During the past 75 years, the proportion of elderly individuals in the USA has grown twice as fast as the general population. Depression in this age-group occurs four times more frequently than in ...the general population (Butler, 1975), and the suicide rate for people over 65 years of age is 15 times greater than that of the general population (Lehman, 1980). The elderly may be more susceptible to depression due to biological and/or psychosocial variables. Elderly people experience significant losses associated with increasing age, including death of spouse and friends, loss of work, social status, and physical and mental abilities (Lehman, 1980). The biogenic amine hypothesis suggests that the aging brain may experience a decrease in the functional availability of neurotransmitters (Lehman, 1980); this decrease may also play a role in the aetiology of depression. Due to age-related changes in the body, the elderly can be more sensitive to drug therapy. Older patients may require careful dosage adjustments and may also be more prone to experiencing drug-related adverse events. The elderly often receive medication for various indications, and drug interactions are a concern (Thompson et al, 1983). Therefore, efficacy and safety studies of new antidepressants in elderly patients are particularly important. We pooled data from both double-blind and open-label studies to evaluate the efficacy and safety of fluoxetine in geriatric outpatients with DSM-III major depression. Positive results of fluoxetine in the treatment of geriatric depression were reported in one of these studies (Feighner & Cohn, 1985). The favourable safety and side-effect profile of fluoxetine in the general population has been discussed elsewhere (Wernicke, 1985). Plasma concentrations of fluoxetine in elderly subjects are similar to those in younger individuals (I.emberger et al, 1985). These findings, combined with a lack of cardiovascular effects (Fisch, 1985), and low lethality with overdose, indicated promise for fluoxetine as a geriatric antidepressant.
Pooled data for 427 patients with generalized anxiety disorders were analyzed retrospectively from six double-blind trials evaluating buspirone, a nonbenzodiazepine anxiolytic, in the treatment of ...generalized anxiety disorder. After a 4- to 7-day washout period, patients were allocated at random to receive treatment over a 4-week period. Buspirone dose ranged from 10 to 60 mg. Patients were assessed on entry and at weekly intervals using the 14 symptom groups (items) of the Hamilton Anxiety Rating Scale (HAM-A). Buspirone improved all symptom groups significantly; onset of anxiolytic activity was observed at week 1 in 3 groups of psychic symptoms of anxiety. Within 2 weeks, 8 of the 14 symptom groups were improved significantly by buspirone versus placebo, and symptoms of anxiety improved further up to the 4-week end point. Psychic symptoms of anxiety improved earlier in general than the somatic symptoms of anxiety. At the end of treatment, analyses of the HAM-A scores indicated that all of the 14 symptom groups (individual items), the total HAM-A score, and the 2 composite Psychic and Somatic Anxiety Factors were significantly improved with buspirone as compared to placebo. The beneficial effects of buspirone were not compromised by any significant side effects.
The treatment of anxiety is one of the leading problems in medicine today. Although traditional anxiolytic drugs have been effective in reducing the symptoms of anxiety, their efficacy has often been ...achieved at the expense of the patient's quality of life. The sedative side effects and impaired psychomotor functioning associated with the use of benzodiazepine anxiolytics not only impede the success of therapy, but jeopardize the patient's safety. This article addresses these salient issues and provides evidence suggesting that the antianxiety drug buspirone better achieves the goal of optimal anxiolytic therapy with minimal unwanted effects.
