Academic journal article Indian Journal of Psychiatry

Research on Antidepressants in India

Academic journal article Indian Journal of Psychiatry

Research on Antidepressants in India

Article excerpt

Byline: Ajit. Avasthi, Sandeep. Grover, Munish. Aggarwal

Data suggests that antidepressants are useful in the management of depressive disorders, anxiety disorders, sexual dysfunction, eating disorders, impulse control disorders, enuresis, aggression and some personality disorders. Research focusing on the usefulness of antidepressants in India has more or less followed the trends seen in the West. Most of the studies conducted in India have evaluated various antidepressants in depression. In this article, we review studies conducted in India on various antidepressants. The data suggests that antidepressants have been evaluated mainly in the acute phase treatment and rare studies have evaluated the efficacy in continuation phase treatment.

Introduction

Antidepressants as a class of drugs are used primarily in the management of depressive disorders and anxiety disorders. However, this class of drugs is also used for the management of sexual dysfunction, eating disorders, impulse control disorders, enuresis, aggression and some personality disorders.

Over the years many classes of antidepressants have become available in India, some of which have stood the test of time and are still in use and some, which are no more marketed or are no more a favorite of clinicians. The research focusing the usefulness of antidepressants in India has more or less followed the trends in the west; however, some of the antidepressants drugs which have been marketed have not been evaluated as thoroughly as others.

Most of the studies done in India have evaluated various antidepressants in depression. There are very few studies which have evaluated antidepressants in conditions other than depressive disorders. In this article, we review studies done in India on various antidepressants. The review shall focus on the research published in Indian Journal of Psychiatry and studies reported in PubMed indexed journals on efficacy, effectiveness, usefulness and tolerability issues of antidepressants in human subjects.

Efficacy/effectiveness in Depression

The trials done to evaluate the efficacy of antidepressants can be divided into studies evaluating an antidepressant (no comparator studies), efficacy of an antidepressant with placebo as a comparator, comparing efficacy of 2 active drugs and those evaluating the efficacy of antidepressants with other modalities of treatment like electro-convulsive therapy or psychological treatment.

Non Comparative Studies

A total of 18 open trials without a comparator group have been conducted to evaluate the efficacy of various antidepressants [Table 1]. [sup][1],[2],[3],[4],[5],[6],[7],[8],[9],[10],[11],[12],[13],[14],[15],[16],[17],[18] Studies done in the 1960s evaluated the efficacy of tricyclic antidepressants. Later studies have evaluated the efficacy of nitroxazepine, centpropazine, amineptine, tianeptine, sertraline and milnacipran. Studies done prior to 1990s have not used any standardized rating scales, most of these also did not mention the diagnostic criteria used for the diagnosis. These studies included subjects diagnosed with various subtypes like reactive depression, endogenous depression, psychoneurotic depression, melancholic depression etc. However, the studies done after 1990s have recruited subjects diagnosed on the basis of DSM or ICD-10 RDC criteria and used standardized rating scales to evaluate the efficacy or effectiveness. The sample sizes of the studies have varied a lot, most of the earlier studies included less than 50 subjects; however, some of the recent studies have included more than 300 subjects. Most of these trials have evaluated the outcome after six weeks. All these trials have shown that various tricyclic antidepressants, nitroxazepine, centpropazine, amineptine, tianeptine, sertraline, escitalopram and milnacipran are efficacious in treatment of depression. The trial which evaluated the efficacy of sertraline also showed that treatment of depression with sertraline leads to reduction in cardiac events post myocardial infarction. …

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