Skip to main page content
U.S. flag

An official website of the United States government

Dot gov

The .gov means it’s official.
Federal government websites often end in .gov or .mil. Before sharing sensitive information, make sure you’re on a federal government site.

Https

The site is secure.
The https:// ensures that you are connecting to the official website and that any information you provide is encrypted and transmitted securely.

Access keys NCBI Homepage MyNCBI Homepage Main Content Main Navigation
Meta-Analysis
. 2002 Nov 2;325(7371):991.
doi: 10.1136/bmj.325.7371.991.

Meta-analysis of effects and side effects of low dosage tricyclic antidepressants in depression: systematic review

Toshi A Furukawa  1 , Hugh McGuire, Corrado Barbui
Affiliations
Meta-Analysis

Meta-analysis of effects and side effects of low dosage tricyclic antidepressants in depression: systematic review

Toshi A Furukawa et al. BMJ. .

Abstract

Objective: To compare the effects and side effects of low dosage tricyclic antidepressants with placebo and with standard dosage tricyclics in acute phase treatment of depression.

Design: Systematic review of randomised trials comparing low dosage tricyclics (< or =100 mg/day) with placebo or with standard dosage tricyclics in adults with depression.

Main outcome measures: Relative risk of response in depression (random effects model), according to the original authors' definition but usually defined as 50% or greater reduction in severity of depression. Relative risks of overall dropouts and dropouts due to side effects.

Results: 35 studies (2013 participants) compared low dosage tricyclics with placebo, and six studies (551 participants) compared low dosage tricyclics with standard dosage tricyclics. Low dosage tricyclics, mostly between 75 and 100 mg/day, were 1.65 (95% confidence interval 1.36 to 2.0) and 1.47 (1.12 to 1.94) times more likely than placebo to bring about response at 4 weeks and 6-8 weeks, respectively. Standard dosage tricyclics failed, however, to bring about more response but produced more dropouts due to side effects than low dosage tricyclics.

Conclusions: Treatment of depression in adults with low dose tricyclics is justified. However, more rigorous studies are needed to definitively establish the relative benefits and harms of various dosages.

PubMed Disclaimer

Figures

Figure 1
Figure 1
Process of inclusion of studies for review and analysis
Figure 2
Figure 2
Low dosage tricyclics versus placebo for all depression: per protocol relative risk of response
Figure 3
Figure 3
Low dosage tricyclics versus placebo for all depression: per protocol standardised weighted mean difference in depressive severity
Figure 4
Figure 4
Low dosage tricyclics versus standard dosage tricyclics for all depression: per protocol relative risk of response
See this image and copyright information in PMC

Comment in

References

    1. Lawrenson RA, Tyrer F, Newson RB, Farmer RD. The treatment of depression in UK general practice: selective serotonin reuptake inhibitors and tricyclic antidepressants compared. J Affect Disord. 2000;59:149–157. - PubMed
    1. Pincus HA, Tanielian TL, Marcus SC, Olfson M, Zarin DA, Thompson J, et al. Prescribing trends in psychotropic medications: primary care, psychiatry, and other medical specialties. JAMA. 1998;279:526–531. - PubMed
    1. Sleath BL, Rubin RH, Huston SA. Antidepressant prescribing to Hispanic and non-Hispanic white patients in primary care. Ann Pharmacother. 2001;35(4):419–423. - PubMed
    1. Roberts E, Norris P. Growth and change in the prescribing of anti-depressants in New Zealand: 1993-1997. N Z Med J. 2001;114:25–27. - PubMed
    1. Depression Guideline Panel. Clinical practice guideline: depression in primary care 2: treatment of major depression. Rockville, MD: US Department of Heath and Human Services, Agency for Health Care Policy and Research; 1993. . [AHCPR Publication 93-0551.]

Publication types

MeSH terms

Substances