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James Mason - One of the best experts on this subject based on the ideXlab platform.
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The Cochrane Library - Treatment discontinuation with selective Serotonin Reuptake Inhibitors (SSRIs) versus tricyclic antidepressants (TCAs)
The Cochrane database of systematic reviews, 2007Co-Authors: Corrado Barbui, Nick Freemantle, Matthew Hotopf, J Boynton, Rachel Churchill, John R. Geddes, Rebecca Hardy, Glyn Lewis, Martin P Eccles, James MasonAbstract:Selective Serotonin Reuptake Inhibitors are thought to have better discontinuation rates (i.e. less people dropping out) than tricyclic and heterocyclic antidepressant drugs. It is important to quantify the drop-out rates of different antidepressant drugs in order to have a better understanding of the relative tolerability of these drugs. To assess the comparative tolerability of selective Serotonin Reuptake Inhibitors and tricyclic/heterocyclic antidepressant drugs. We searched the Cochrane Collaboration Depression, Anxiety and Neurosis Controlled Trials Registers (1997 to 1999), MEDLINE (1966 to 1999), EMBASE (1974 to 1999) We also searched specialist journals, the reference lists of relevant papers and previous systematic reviews, conference abstracts and government documents. Representatives of the pharmaceutical industry were contacted. Parallel group randomised controlled trials comparing selective Serotonin Reuptake Inhibitors with tricyclic or heterocyclic antidepressants in people with depression. Two reviewers independently extracted data and a third reviewer checked any cases of disagreement. We included 136 trials. The selective Serotonin Reuptake Inhibitors showed less participants dropping out compared to the tricyclic/heterocyclic group (odds ratio 1.21, 95% confidence interval 1.12 to 1.30). A statistically significant difference was found in total drop-outs between the selective Serotonin Reuptake Inhibitors and the old tricyclics as well as the newer tricyclics. When the selective Serotonin Reuptake Inhibitors were compared to the heterocyclic antidepressants, there was a non significant difference favouring the selective Serotonin Reuptake Inhibitors. The poor tolerability profile of the old tricyclics was explained by differences in drop-outs for side-effects, but not for inefficacy. Whilst selective Serotonin Reuptake Inhibitors do appear to show an advantage over tricyclic drugs in terms of total drop-outs, this advantage is relatively modest. This has implications for pharmaco-economic models, some of which may have overestimated the difference of drop-out rates between selective Serotonin Reuptake Inhibitors and tricyclic antidepressants. These results are based on short-term randomised controlled trials, and may not generalise into clinical practice.
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Selective Serotonin Reuptake Inhibitors versus tricyclic and heterocyclic antidepressants: comparison of drug adherence.
The Cochrane database of systematic reviews, 2000Co-Authors: Corrado Barbui, Nick Freemantle, Matthew Hotopf, J Boynton, Rachel Churchill, M Eccles, John R. Geddes, Rebecca Hardy, Glyn Lewis, James MasonAbstract:Selective Serotonin Reuptake Inhibitors are thought to have better discontinuation rates (i.e. less people dropping out) than tricyclic and heterocyclic antidepressant drugs. It is important to quantify the drop-out rates of different antidepressant drugs in order to have a better understanding of the relative tolerability of these drugs. To assess the comparative tolerability of selective Serotonin Reuptake Inhibitors and tricyclic/heterocyclic antidepressant drugs. We searched the Cochrane Collaboration Depression, Anxiety and Neurosis Controlled Trials Registers (1997 to 1999), MEDLINE (1966 to 1999), EMBASE (1974 to 1999) We also searched specialist journals, the reference lists of relevant papers and previous systematic reviews, conference abstracts and government documents. Representatives of the pharmaceutical industry were contacted. Parallel group randomised controlled trials comparing selective Serotonin Reuptake Inhibitors with tricyclic or heterocyclic antidepressants in people with depression. Two reviewers independently extracted data and a third reviewer checked any cases of disagreement. We included 136 trials. The selective Serotonin Reuptake Inhibitors showed less participants dropping out compared to the tricyclic/heterocyclic group (odds ratio 1.21, 95% confidence interval 1.12 to 1.30). A statistically significant difference was found in total drop-outs between the selective Serotonin Reuptake Inhibitors and the old tricyclics as well as the newer tricyclics. When the selective Serotonin Reuptake Inhibitors were compared to the heterocyclic antidepressants, there was a non significant difference favouring the selective Serotonin Reuptake Inhibitors. The poor tolerability profile of the old tricyclics was explained by differences in drop-outs for side-effects, but not for inefficacy. Whilst selective Serotonin Reuptake Inhibitors do appear to show an advantage over tricyclic drugs in terms of total drop-outs, this advantage is relatively modest. This has implications for pharmaco-economic models, some of which may have overestimated the difference of drop-out rates between selective Serotonin Reuptake Inhibitors and tricyclic antdepressants. These results are based on short-term randomised controlled trials, and may not generalise into clinical practice.
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Prescribing selective Serotonin Reuptake Inhibitors as strategy for prevention of suicide
BMJ (Clinical research ed.), 1994Co-Authors: Nick Freemantle, Allan House, James Mason, Song F, Trevor A SheldonAbstract:To evaluate a policy to reduce the incidence of suicide by means of changing the prescribing of antidepressants from the older tricyclic antidepressants to the routine first line use of selective Serotonin Reuptake Inhibitors or newer tricyclic and related antidepressants. Cost effectiveness analysis with sensitivity analyses using observational data on costs, volume of prescribing, deaths, and toxicity. United Kingdom primary care. Selective Serotonin Reuptake Inhibitors or newer tricyclic and related antidepressants compared with the use of older tricyclics. Cost per life saved and cost per life year saved. The potential number of lives which may be saved from a switch to the routine first line use of selective Serotonin Reuptake Inhibitors is between 300 and 450 each year. The cost per life year gained ranges from 19,000 pounds to 173,000 pounds, depending on the assumptions used. The cost per life year gained through the use of the newer tricyclic and related antidepressants is considerably lower. The cost per life year gained through avoiding suicides by the routine first line use of Serotonin Reuptake Inhibitors is likely to be high. The new tricyclics and related drugs are of similar toxicity to the Serotonin Reuptake Inhibitors but are considerably cheaper and so are most cost effective for this purpose. Further research is required on such prescribing. Because of the great uncertainties the shift to considerably more expensive options must be further investigated.
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Selective Serotonin Reuptake Inhibitors: meta-analysis of efficacy and acceptability.
BMJ (Clinical research ed.), 1993Co-Authors: Fujian Song, Nick Freemantle, Trevor A Sheldon, Allan House, Paul J. Watson, Andrew F. Long, James MasonAbstract:To examine the evidence for using selective Serotonin Reuptake Inhibitors instead of tricyclic antidepressants in the first line treatment of depression. Meta-analysis of 63 randomised controlled trials comparing the efficacy and acceptability of selective Serotonin Reuptake Inhibitors with those of tricyclic and related antidepressants. Improvement in mean scores on Hamilton depression rating scale for 53 randomised controlled trials. Pooled drop out rates from the 58 trials which reported drop out by treatment group. Among the 20 studies reporting standard deviation for the Hamilton score no difference was found in efficacy between Serotonin Reuptake Inhibitors and tricyclic and related antidepressants (standardised mean difference 0.004, 95% confidence interval -0.096 to 0.105). The difference remained insignificant when the remaining 33 studies that used the 17 item and 21 item Hamilton score were included by ascribing weighted standard deviations. The odds ratio for drop out rate in patients receiving Serotonin Reuptake Inhibitors compared with those receiving tricyclic antidepressants was 0.95 (0.86 to 1.07). Similar proportions in both groups cited lack of efficacy as the reason for dropping out but slightly more patients in the tricyclic group cited side effects (18.8% v 15.4% in Serotonin Reuptake group). Routine use of selective Serotonin Reuptake Inhibitors as the first line treatment of depressive illness may greatly increase cost with only questionable benefit.
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selective Serotonin Reuptake Inhibitors meta analysis of efficacy and acceptability
BMJ, 1993Co-Authors: Fujian Song, Nick Freemantle, Trevor A Sheldon, Allan House, Paul J. Watson, Andrew F. Long, James MasonAbstract:OBJECTIVE--To examine the evidence for using selective Serotonin Reuptake Inhibitors instead of tricyclic antidepressants in the first line treatment of depression. DESIGN--Meta-analysis of 63 randomised controlled trials comparing the efficacy and acceptability of selective Serotonin Reuptake Inhibitors with those of tricyclic and related antidepressants. MAIN OUTCOME MEASURES--Improvement in mean scores on Hamilton depression rating scale for 53 randomised controlled trials. Pooled drop out rates from the 58 trials which reported drop out by treatment group. RESULTS--Among the 20 studies reporting standard deviation for the Hamilton score no difference was found in efficacy between Serotonin Reuptake Inhibitors and tricyclic and related antidepressants (standardised mean difference 0.004, 95% confidence interval -0.096 to 0.105). The difference remained insignificant when the remaining 33 studies that used the 17 item and 21 item Hamilton score were included by ascribing weighted standard deviations. The odds ratio for drop out rate in patients receiving Serotonin Reuptake Inhibitors compared with those receiving tricyclic antidepressants was 0.95 (0.86 to 1.07). Similar proportions in both groups cited lack of efficacy as the reason for dropping out but slightly more patients in the tricyclic group cited side effects (18.8% v 15.4% in Serotonin Reuptake group). CONCLUSIONS--Routine use of selective Serotonin Reuptake Inhibitors as the first line treatment of depressive illness may greatly increase cost with only questionable benefit.
Nick Freemantle - One of the best experts on this subject based on the ideXlab platform.
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The Cochrane Library - Treatment discontinuation with selective Serotonin Reuptake Inhibitors (SSRIs) versus tricyclic antidepressants (TCAs)
The Cochrane database of systematic reviews, 2007Co-Authors: Corrado Barbui, Nick Freemantle, Matthew Hotopf, J Boynton, Rachel Churchill, John R. Geddes, Rebecca Hardy, Glyn Lewis, Martin P Eccles, James MasonAbstract:Selective Serotonin Reuptake Inhibitors are thought to have better discontinuation rates (i.e. less people dropping out) than tricyclic and heterocyclic antidepressant drugs. It is important to quantify the drop-out rates of different antidepressant drugs in order to have a better understanding of the relative tolerability of these drugs. To assess the comparative tolerability of selective Serotonin Reuptake Inhibitors and tricyclic/heterocyclic antidepressant drugs. We searched the Cochrane Collaboration Depression, Anxiety and Neurosis Controlled Trials Registers (1997 to 1999), MEDLINE (1966 to 1999), EMBASE (1974 to 1999) We also searched specialist journals, the reference lists of relevant papers and previous systematic reviews, conference abstracts and government documents. Representatives of the pharmaceutical industry were contacted. Parallel group randomised controlled trials comparing selective Serotonin Reuptake Inhibitors with tricyclic or heterocyclic antidepressants in people with depression. Two reviewers independently extracted data and a third reviewer checked any cases of disagreement. We included 136 trials. The selective Serotonin Reuptake Inhibitors showed less participants dropping out compared to the tricyclic/heterocyclic group (odds ratio 1.21, 95% confidence interval 1.12 to 1.30). A statistically significant difference was found in total drop-outs between the selective Serotonin Reuptake Inhibitors and the old tricyclics as well as the newer tricyclics. When the selective Serotonin Reuptake Inhibitors were compared to the heterocyclic antidepressants, there was a non significant difference favouring the selective Serotonin Reuptake Inhibitors. The poor tolerability profile of the old tricyclics was explained by differences in drop-outs for side-effects, but not for inefficacy. Whilst selective Serotonin Reuptake Inhibitors do appear to show an advantage over tricyclic drugs in terms of total drop-outs, this advantage is relatively modest. This has implications for pharmaco-economic models, some of which may have overestimated the difference of drop-out rates between selective Serotonin Reuptake Inhibitors and tricyclic antidepressants. These results are based on short-term randomised controlled trials, and may not generalise into clinical practice.
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Selective Serotonin Reuptake Inhibitors versus tricyclic and heterocyclic antidepressants: comparison of drug adherence.
The Cochrane database of systematic reviews, 2000Co-Authors: Corrado Barbui, Nick Freemantle, Matthew Hotopf, J Boynton, Rachel Churchill, M Eccles, John R. Geddes, Rebecca Hardy, Glyn Lewis, James MasonAbstract:Selective Serotonin Reuptake Inhibitors are thought to have better discontinuation rates (i.e. less people dropping out) than tricyclic and heterocyclic antidepressant drugs. It is important to quantify the drop-out rates of different antidepressant drugs in order to have a better understanding of the relative tolerability of these drugs. To assess the comparative tolerability of selective Serotonin Reuptake Inhibitors and tricyclic/heterocyclic antidepressant drugs. We searched the Cochrane Collaboration Depression, Anxiety and Neurosis Controlled Trials Registers (1997 to 1999), MEDLINE (1966 to 1999), EMBASE (1974 to 1999) We also searched specialist journals, the reference lists of relevant papers and previous systematic reviews, conference abstracts and government documents. Representatives of the pharmaceutical industry were contacted. Parallel group randomised controlled trials comparing selective Serotonin Reuptake Inhibitors with tricyclic or heterocyclic antidepressants in people with depression. Two reviewers independently extracted data and a third reviewer checked any cases of disagreement. We included 136 trials. The selective Serotonin Reuptake Inhibitors showed less participants dropping out compared to the tricyclic/heterocyclic group (odds ratio 1.21, 95% confidence interval 1.12 to 1.30). A statistically significant difference was found in total drop-outs between the selective Serotonin Reuptake Inhibitors and the old tricyclics as well as the newer tricyclics. When the selective Serotonin Reuptake Inhibitors were compared to the heterocyclic antidepressants, there was a non significant difference favouring the selective Serotonin Reuptake Inhibitors. The poor tolerability profile of the old tricyclics was explained by differences in drop-outs for side-effects, but not for inefficacy. Whilst selective Serotonin Reuptake Inhibitors do appear to show an advantage over tricyclic drugs in terms of total drop-outs, this advantage is relatively modest. This has implications for pharmaco-economic models, some of which may have overestimated the difference of drop-out rates between selective Serotonin Reuptake Inhibitors and tricyclic antdepressants. These results are based on short-term randomised controlled trials, and may not generalise into clinical practice.
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Prescribing selective Serotonin Reuptake Inhibitors as strategy for prevention of suicide
BMJ (Clinical research ed.), 1994Co-Authors: Nick Freemantle, Allan House, James Mason, Song F, Trevor A SheldonAbstract:To evaluate a policy to reduce the incidence of suicide by means of changing the prescribing of antidepressants from the older tricyclic antidepressants to the routine first line use of selective Serotonin Reuptake Inhibitors or newer tricyclic and related antidepressants. Cost effectiveness analysis with sensitivity analyses using observational data on costs, volume of prescribing, deaths, and toxicity. United Kingdom primary care. Selective Serotonin Reuptake Inhibitors or newer tricyclic and related antidepressants compared with the use of older tricyclics. Cost per life saved and cost per life year saved. The potential number of lives which may be saved from a switch to the routine first line use of selective Serotonin Reuptake Inhibitors is between 300 and 450 each year. The cost per life year gained ranges from 19,000 pounds to 173,000 pounds, depending on the assumptions used. The cost per life year gained through the use of the newer tricyclic and related antidepressants is considerably lower. The cost per life year gained through avoiding suicides by the routine first line use of Serotonin Reuptake Inhibitors is likely to be high. The new tricyclics and related drugs are of similar toxicity to the Serotonin Reuptake Inhibitors but are considerably cheaper and so are most cost effective for this purpose. Further research is required on such prescribing. Because of the great uncertainties the shift to considerably more expensive options must be further investigated.
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Selective Serotonin Reuptake Inhibitors: meta-analysis of efficacy and acceptability.
BMJ (Clinical research ed.), 1993Co-Authors: Fujian Song, Nick Freemantle, Trevor A Sheldon, Allan House, Paul J. Watson, Andrew F. Long, James MasonAbstract:To examine the evidence for using selective Serotonin Reuptake Inhibitors instead of tricyclic antidepressants in the first line treatment of depression. Meta-analysis of 63 randomised controlled trials comparing the efficacy and acceptability of selective Serotonin Reuptake Inhibitors with those of tricyclic and related antidepressants. Improvement in mean scores on Hamilton depression rating scale for 53 randomised controlled trials. Pooled drop out rates from the 58 trials which reported drop out by treatment group. Among the 20 studies reporting standard deviation for the Hamilton score no difference was found in efficacy between Serotonin Reuptake Inhibitors and tricyclic and related antidepressants (standardised mean difference 0.004, 95% confidence interval -0.096 to 0.105). The difference remained insignificant when the remaining 33 studies that used the 17 item and 21 item Hamilton score were included by ascribing weighted standard deviations. The odds ratio for drop out rate in patients receiving Serotonin Reuptake Inhibitors compared with those receiving tricyclic antidepressants was 0.95 (0.86 to 1.07). Similar proportions in both groups cited lack of efficacy as the reason for dropping out but slightly more patients in the tricyclic group cited side effects (18.8% v 15.4% in Serotonin Reuptake group). Routine use of selective Serotonin Reuptake Inhibitors as the first line treatment of depressive illness may greatly increase cost with only questionable benefit.
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selective Serotonin Reuptake Inhibitors meta analysis of efficacy and acceptability
BMJ, 1993Co-Authors: Fujian Song, Nick Freemantle, Trevor A Sheldon, Allan House, Paul J. Watson, Andrew F. Long, James MasonAbstract:OBJECTIVE--To examine the evidence for using selective Serotonin Reuptake Inhibitors instead of tricyclic antidepressants in the first line treatment of depression. DESIGN--Meta-analysis of 63 randomised controlled trials comparing the efficacy and acceptability of selective Serotonin Reuptake Inhibitors with those of tricyclic and related antidepressants. MAIN OUTCOME MEASURES--Improvement in mean scores on Hamilton depression rating scale for 53 randomised controlled trials. Pooled drop out rates from the 58 trials which reported drop out by treatment group. RESULTS--Among the 20 studies reporting standard deviation for the Hamilton score no difference was found in efficacy between Serotonin Reuptake Inhibitors and tricyclic and related antidepressants (standardised mean difference 0.004, 95% confidence interval -0.096 to 0.105). The difference remained insignificant when the remaining 33 studies that used the 17 item and 21 item Hamilton score were included by ascribing weighted standard deviations. The odds ratio for drop out rate in patients receiving Serotonin Reuptake Inhibitors compared with those receiving tricyclic antidepressants was 0.95 (0.86 to 1.07). Similar proportions in both groups cited lack of efficacy as the reason for dropping out but slightly more patients in the tricyclic group cited side effects (18.8% v 15.4% in Serotonin Reuptake group). CONCLUSIONS--Routine use of selective Serotonin Reuptake Inhibitors as the first line treatment of depressive illness may greatly increase cost with only questionable benefit.
Ilan Matok - One of the best experts on this subject based on the ideXlab platform.
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prenatal exposure to selective Serotonin Reuptake Inhibitors and Serotonin norepinephrine Reuptake Inhibitors and risk for persistent pulmonary hypertension of the newborn a systematic review meta analysis and network meta analysis
American Journal of Obstetrics and Gynecology, 2019Co-Authors: Reem Masarwa, Benjamin Baroz, Einat Gorelik, Shimon Reif, Amichai Perlman, Ilan MatokAbstract:Background There is a marked increase in the use of selective Serotonin Reuptake Inhibitors and Serotonin norepinephrine Reuptake Inhibitors in the last decade. Many newborns are likely to be exposed during pregnancy and labor. Objective We aimed to evaluate the association between exposure to selective Serotonin Reuptake Inhibitors and Serotonin norepinephrine Reuptake Inhibitors during pregnancy and the risk for persistent pulmonary hypertension of the newborn. We sought to compare the risk for persistent pulmonary hypertension of the newborn between specific selective Serotonin Reuptake inhibitor agents. Study Design MEDLINE, Embase, and Cochrane were searched up to July 2017. No language restrictions were applied. Search key words included: “SSRI,” “SNRI,” “pregnancy,” “risk,” “new-born,” and “pulmonary hypertension.” Retrospective cohort studies and case-control studies reporting the risk for persistent pulmonary hypertension of the newborn in the offspring of women exposed to selective Serotonin Reuptake Inhibitors or Serotonin norepinephrine Reuptake Inhibitors during pregnancy, were extracted. Two independent researchers identified relevant data. Random effects meta-analysis was used to pool results. Odds ratios were calculated with subsequent 95% confidence intervals. Network meta-analysis was conducted, incorporating direct and indirect comparisons among different selective Serotonin Reuptake Inhibitors. The primary outcome was risk for persistent pulmonary hypertension of the newborn after exposure to selective Serotonin Reuptake Inhibitors or Serotonin norepinephrine Reuptake Inhibitors during pregnancy. Results A total of 11 studies were identified. A total of 156,978 women and their offspring were exposed to selective Serotonin Reuptake Inhibitors or Serotonin norepinephrine Reuptake Inhibitors during pregnancy. Persistent pulmonary hypertension of the newborn was detected among 452 exposed offspring, representing an incidence rate of 2.9 cases per 1000 live births and a number needed to harm of 1000. The risk for persistent pulmonary hypertension of the newborn was significantly increased in the analysis of exposure to selective Serotonin Reuptake inhibitor/Serotonin norepinephrine Reuptake inhibitor in any trimester (odds ratio, 1.82; 95% confidence interval, 1.31–2.54; I2 = 72%), as well as in analysis restricted to exposure week >20 (odds ratio, 2.08; 95% confidence interval, 1.44–3.01; I2 = 76%). In network meta-analysis, sertraline was ranked most likely to have the lowest risk for persistent pulmonary hypertension of the newborn among the different selective Serotonin Reuptake Inhibitors (P = .83). Conclusion Exposure to selective Serotonin Reuptake Inhibitors or Serotonin norepinephrine Reuptake Inhibitors during pregnancy is associated with an increased risk for persistent pulmonary hypertension of the newborn. According to our findings, sertraline ranked as most likely to have the lowest risk for persistent pulmonary hypertension of the newborn compared to other selective Serotonin Reuptake Inhibitors, suggesting it may have the best safety profile for use in pregnancy in this regard. Further studies are needed to fully establish these results.
Viktoria Sjoblom - One of the best experts on this subject based on the ideXlab platform.
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selective Serotonin Reuptake Inhibitors and persistent pulmonary hypertension of the newborn
The New England Journal of Medicine, 2006Co-Authors: Par Hallberg, Viveca Odlind, Viktoria SjoblomAbstract:Selective Serotonin-Reuptake Inhibitors and persistent pulmonary hypertension of the newborn
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The use of selective Serotonin Reuptake Inhibitors during pregnancy and breast-feeding: a review and clinical aspects.
Journal of clinical psychopharmacology, 2005Co-Authors: Par Hallberg, Viktoria SjoblomAbstract:Mood and anxiety disorders are common in women during their childbearing years. The prevalence of depression has been reported to be between 10% and 16% during pregnancy. The use of selective Serotonin Reuptake Inhibitors during pregnancy or lactation is, to date, not promoted because of lack of safety documentation. However, the off-label use of these drugs has been common for several years. In the treatment of mood and anxiety disorders during pregnancy, the Serotonin Reuptake Inhibitors are often preferred over tricyclic antidepressants because of their relatively few adverse effects and safety in overdose. This has created concern among women planning pregnancies and pregnant women, as well as among their families and physicians. Several studies and reports of the use of Serotonin Reuptake Inhibitors during both pregnancy and lactation have been published and advanced our knowledge. We here review and discuss those studies which have been published so far on this subject.
Ruth B. Lathi - One of the best experts on this subject based on the ideXlab platform.
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Effect of selective Serotonin Reuptake Inhibitors on in vitro fertilization outcome.
Fertility and sterility, 2009Co-Authors: B.e. Friedman, Jayna Rogers, Lora K. Shahine, Lynn M. Westphal, Ruth B. LathiAbstract:A review of 950 patients was performed to investigate the impact of selective Serotonin Reuptake Inhibitors (SSRIs) on in vitro fertilization outcome. The 41 patients (4.3%) taking an SSRI had a higher cycle cancellation rate but no statistically significant difference in pregnancy rate and live birth rate per cycle started.
