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
poster:Mtom
thread:1116347
URL: http://www.dr-bob.org/babble/20210723/msgs/1116347.html