Summary
Selective serotonin reuptake inhibitors (SSRIs) are a recently developed class of drugs with significantly greater antidepressant efficacy than placebo. Generally, in double-blind comparative trials, all SSRIs demonstrated antidepressant efficacy similar to that of the ‘standard’ tricyclic antidepressants amitriptyline and imipramine; a meta-analysis of controlled trials found the efficacy of the SSRIs to be equivalent to that of the 2 tricyclics. Nevertheless, because of small patient numbers included in most studies that compare SSRIs with other antidepressants, no definitive statements about relative efficacy can be made. In these studies it is simply possible to state that no statistically significant differences were identified between SSRIs and the comparative antidepressants. Importantly, differences in clinical characteristics exist between the SSRIs — differences in elimination half-life (t½β) between fluoxetine and/or its metabolite (total t½β = 330 hours) and other SSRIs (t½β range = 15 to 30 hours), for example. This has implications in terms of potential drug interactions and must be considered when patients have to be switched to treatment with monoamine oxidase inhibitors.
Studies with fluvoxamine have been conducted in both in- and outpatients, whereas trials with other SSRIs have been confined largely to outpatient populations. Fluvoxamine has been associated with a high incidence of nausea (37%), although this may have resulted from high initial dosages (rather than upward dose titration protocols) used in early trials. Of further interest, fluoxetine doses of 20mg may be sufficient to produce a satisfactory antidepressant response, and this SSRI may be particularly useful in patients with chronic retarded depression. More clinical data are required before the efficacy of sertraline and citalopram relative to standard antidepressants can be clearly defined. Preliminary data indicate that SSRIs are effective in the treatment of panic disorder, obsessive-compulsive disorder (OCD), eating (e.g. anorexia and bulimia) and personality disorders (e.g. anger, impulsiveness) and substance abuse (e.g. alcoholism); early results with fluvoxamine in the treatment of panic disorder and OCD, and with fluoxetine in the treatment of bulimia, personality disorders and alcohol abuse, have been encouraging.
SSRIs have a more favourable tolerability profile than tricyclic antidepressants and, unlike the tricyclics, are not associated with anticholinergic adverse effects, sedation, cardiotoxicity or weight gain. SSRIs are associated with a relatively high incidence of nausea, particularly if high doses are used at the start of treatment. However, the incidence of nausea appears to decrease as treatment is continued. Although SSRIs appear to be well tolerated, they are a new drug class and, thus, patients should be monitored carefully for the occurrence of unexpected adverse reactions (e.g. the ‘flu-like’ illness noted in a small number of zimeldine recipients).
Overall, SSRIs have been shown to be effective and safe agents for the treatment of patients with major depressive disorders. These drugs possess tolerability advantages over tricyclic antidepressants, and preliminary evidence suggests that they may have future value in the treatment of panic disorder, OCD, eating and personality disorders, and substance abuse.
Similar content being viewed by others
References
Abell C, Farquhar DI, Galloway SM, et al. Placebo controlled double-blind trial of fluvoxamine maleate in the obese. Journal of Psychosomatic Research 30: 143–146, 1986
Ahlfors UG, Elovaara S, Harma P, Suoniemi I, Heikkila L, et al. Clinical multicenter study of citalopram compared double-blindly with mianserin in depressed patients in Finland. Nordisk Psykiatrisk Tidsskrift 42: 201–210, 1988
Altamura AC, Percudani M, Guercetti G, et al. Efficacy and tolerability of fluoxetine in the elderly: a double-blind study versus amitriptyline. International Clinical Psychopharmacology 4 (Suppl. 1): 103–106, 1989
Amin M, Lehmann H, Mirmiran J. A double-blind, placebo-controlled dose-finding study with sertraline. Psychopharmacology Bulletin 25: 164–167, 1989
Amin MM, Ananth JV, Coleman BS, Darcourt G, Farkas T, et al. Fluvoxamine: antidepressant effects confirmed in a placebo-controlled international study. Clinical Neuropharmacology 7 (Suppl. 1): 580–581, 1984
Amore M, Bellini M, Berardi D, Berlinzani L, Cervino G, et al. Double-blind comparison of fluvoxamine and imipramine in depressed patients. Current Therapeutic Research 46: 815–820, 1989
Ashford JJ, Rahman K. Fluvoxamine versus dothiepin: a double-blind study in elderly depressed patients. Journal of Psycho-pharmacology 4: 299, 1990
Bascara L. A double-blind study to compare the effectiveness and tolerability of paroxetine and amitriptyline in depressed patients. Acta Psychiatrica Scandinavica 80 (Suppl. 350): 141–142, 1989
Baxter LJ, Schwartz JM, Phelps ME, et al. Reduction of prefrontal cortex glucose metalbolism common to three types of depression. Archives of General Psychiatry 46: 243–250, 1989
Benkelfat C, Murphy DI, Zohar J, et al. Clomipramine in obsessive-compulsive disorder. Further evidence for serotonergic mechanism of action. Archives of General Psychiatry 46: 23–28, 1989
Bouchard JM, Delaunay J, Delisle JP, Grasset N, Mermberg PF, et al. Citalopram versus maprotiline: a controlled clinical multicentre trial in depressed patients. Acta Psychiatrica Scandinavica 76: 583–592, 1987
Bourin M. A double-blind comparison of paroxetine and clomipramine in depressed outpatients. Abstract. Proceedings of the 17th CINP Congress, Kyoto, Japan, 10–14 September, 1990
Bramanti P, Ricci RM, Roncari R, Bilone F, Inga F, et al. An Italian multicenter experience with fluvoxamine, a new antidepressant drug, versus imipramine. Current Therapeutic Research 43: 718–725, 1988
Carruba MO, Mantegazza P, Momo M, et al. Peripheral and central mechanisms of action of serotoninergic anorectic drugs. Appetite 7: 105–113, 1986
Cassano G, Conti L. Preliminary results: placebo-controlled data on fluvoxamine maleate, a serotonergic antidepressant. Clinical Neuropharmacology 7 (Suppl. 1): S312–S319, 1984
Cassano G, Conti L, Massimetti G, Mengali F, Waekelin JS, et al. Use of a standardized documentation system (BLIPS/BDP) in the conduct of a multicenter international trial comparing fluvoxamine, imipramine and placebo. Psychopharmacology Bulletin 22: 52–58, 1986
Cassano GB, Conti L, Dell’Osso L, Massimetti G. Four new atypical antidepressants (trazodone, mianserin, nomifensine, caroxazone): results of controlled trials. In Costa E, Racagni G (Eds) Typical and atypical antidepressants. Clinical practice, pp. 125–138, Raven Press, New York, 1982
Chouinard G. A double-blind controlled clinical trial of fluoxetine and amitriptyline in the treatment of outpatients with major depressive disorder. Journal of Clinical Psychiatry 46: 32–37, 1985
Clark C, Rosenblatt S. A multicenter study of sertraline in the treatment of diabetic obesity. Paper presented at Progress in the Treatment of Simple and Complicated Obesity, Lisbon, 19 September, 1989
Coccoaro EF, Sieber LJ, Klar HM, et al. Serotonergic studies in patients with affective and personality disorders. Correlates with suicidal and impulsive aggressive behaviour. Archives of General Psychiatry 46: 587–599, 1989
Cohn CK, Shrivastava R, Mendels J, Cohn JB, Fabre LF, et al. Double-blind, multicenter comparison of sertraline and amitriptyline in elderly depressed patients. Journal of Clinical Psychiatry 51: 28–33, 1990a
Cohn JB, Crowder JE, Wilcox CS, Ryan PJ. A placebo and imipramine controlled study of paroxetine. Psychopharmacology Bulletin 26: 185–189, 1990b
Cohn JB, Wilcox C. A comparison of fluoxetine, imipramine and placebo in patients with major depressive disorder. Journal of Clinical Psychiatry 46: 26–31, 1985
Coleman BS, Block BA. Fluvoxamine maleate, a serotonergic antidepressant; a comparison with chlorimipramine. Progress in Neuro-Psychopharmacology and Biological Psychiatry 6: 475–478, 1982
Conti L, Dell’Osso LRF, Mussetti L, Cassano GB. Fluvoxamine maleate: double-blind clinical trial vs placebo in hospitalized depressed patients. Current Therapeutic Research 43: 468–480, 1988
Cornelius JR, Soloff PH, Perel JM, et al. Fluoxetine trial in borderline personality. New research program and abstracts. American Psychiatric Association 142nd Annual Meeting, p. 192, 1989
Danish University Antidepressant Group. Citalopram: clinical effect profile in comparison with clomipramine. A controlled multicenter study. Psychopharmacology 90: 131–138, 1986
Danish University Antidepressant Group. Paroxetine: a selective serotonin reuptake inhibitor showing better tolerance, but weaker antidepressant effect than clomipramine in a controlled multicenter study. Journal of Affective Disorders 18: 289–299, 1990
Deltito JA, Stam M. Pyschopharmacological treatment of avoidant personality disorder. Comprehensive Psychiatry 30: 498–504, 1989
de Jonghe F, Swinkels J, Tuynman-Qua H. Randomized double-blind study of fluvoxamine and maprotiline in treatment of depression. Pharmacopsychiatry 24: 21–27, 1991
de Wilde J, Mertens C, Over KF, et al. Citalopram versus mianserin. A controlled double-blind trial in depressed patients. Acta Psychiatrica Scandinavica 72: 89–96, 1985
de Wilde J, Martens C, Wakelin JS. Clinical trials of fluvoxamine vs chlorimipramine with single and three times daily dosing. British Journal of Clinical Pharmacology 15 (Suppl. 3): 427S–431S, 1983
Dick P, Ferrero E. A double-blind comparative study of the clinical efficacy of fluvoxamine and chlorimipramine. British Journal of Clinical Pharmacology 15 (Suppl. 3): 419S–425S, 1983
Dominguez RA, Goldstein BJ, Jacobson AF, Steinbook RM. A double-blind placebo-controlled study for fluvoxamine and imipramine in depression. Journal of Clinical Psychiatry 46: 84–87, 1985
Donders SH, Pieters GF, Heevel JG, Ross HA, Smals AG, et al. Disparity of thyrotropin (TSH) and prolactin responses to TSH-releasing hormone in obesity. Journal of Clinical Endocrinology and Metabolism 61: 56–59, 1985
Dorman T. A double-blind comparison of paroxetine and mianserin on sleep in elderly depressed hospital patients. Abstract, 17th CINP Congress, Kyoto, Japan, 10–14 September, 1990
Dunbar GC. The efficacy profile of paroxetine, a new antidepressant, compared with imipramine and placebo. 17th CINP Congress Abstracts 1: 17, 1990
Dunbar GC, Fuell D. A comparison of paroxetine and placebo in depressed outpatients. Abstract, 17th CINP Congress, Kyoto, Japan, 10–14th September 1990
Emrich HM, Berger M, Riemann D, von Zerssen D. Serotonin reuptake inhibition vs norepinephrine reuptake inhibition: a double-blind differential-therapeutic study with fluvoxamine and oxaprotiline in endogenous and neurotic depressives. Pharmacopsychiatry 20: 60–63, 1987
Enas GG, Pope HG, Vevine LR. Fluoxetine in bulimia nervosa: double-blind study. New Research Program and Abstracts. American Psychiatric Association 142nd Annual Meeting, p. 204, 1989
Fabre LF. A study of paroxetine, imipramine and placebo in the treatment of depressed outpatients. Abstract, 17th CINP Congress, Kyoto, Japan, 10–14th September, 1990
Fabre LF. A double-blind multicenter study comparing the safety and efficacy of sertraline with placebo in major depression. Biological Psychiatry 29: 353S, 1991
Fabre LF, Crismon L. Efficacy of fluoxetine in outpatients with major depression. Current Therapeutic Research 37: 115–123, 1985
Fawcett J, Zajecka JM, Kravitz HM, Edwards J, Jeffriess H, et al. Fluoxetine versus amitriptyline in adult outpatients with major depression. Current Therapeutic Research 45: 821–832, 1989
Feighner JP. A comparative trial of fluoxetine and amitriptyline in patients with major depressive disorder. Journal of Clinical Psychiatry 46: 369–372, 1985
Feighner JP, Boyer WF. Paroxetine in the the treatment of major depression. Acta Psychiatrica Scandinavica 80 (Suppl. 350): 125–129, 1983
Feighner JP, Boyer W, Meredith CH, Hendrickson GG. A placebo-controlled inpatient comparison of fluvoxamine maleate and imipramine in major depression. International Clinical Psychopharmacology 4: 239–244, 1989
Feighner JP, Rosenblatt S. A double-blind placebo-controlled study of sertraline in the treatment of obesity. Paper presented at Progress in the Treatment of Simple and Complicated Obesity, Lisbon, 19 September, 1989
Ferguson JM, Feighner JP. Fluoxetin-induced weight loss in overweight non-depressed humans. International Journal of Obesity 11: 163–170, 1987
Fieve RR, Goodnick PJ, Peselow ED, Barouche F, Schlegel A. Pattern analysis of antidepressant response to fluoxetine. Journal of Clinical Psychiatry 47: 560–562, 1986
Fuger J, Zinner H-J, Kasper S, Möller H-J. Efficacy of the new generation antidepressants — a statistical metaanalysis. Pharmacopsychiatry, in press, 1992
Gagiano CA, Mueller PGM, Fourie J, et al. The therapeutic efficacy of paroxetine: (a) an open study in patients with major depression not responding to antidepressants; (b) a double-blind comparison with amitriptyline in depressed outpatients. Acta Psychiatrica Scandinavica 80: 130–131, 1989
Glass GVB, McGaw ML, Smith ML. Metaanalysis in social research, Sage publications, Beverly Hills, London, 1981
Gonella G, Baignoli G, Ecari U. Fluvoxamine and imipramine in the treatment of depressive patients: a double-blind controlled study. Current Medical Research and Opinion 12: 177–184, 1990
Goodman WK, Delgado PL, Price LH, et al. Fluvoxamine versus desipramine in OCD. New Research Program and Abstracts, American Psychiatry Asociation 142nd Annual Meeting, p. 186, 1989a
Goodman WK, Price LH, Rasmussen SA, et al. Efficacy of fluvoxamine in obsessive-compulsive disorder: a double-blind comparison with placebo. Archives of General Psychiatry 46: 36–44, 1989b
Gravem A, Amthor KF, Astrup C, Eigen K, Gjessing LR, et al. A double-blind comparison of citalopram (Lu 10–17) and amitriptyline in depressed patients. Acta Psychiatrica Scandinavica 75: 478–486, 1987
Guelfi JD, Dreyfus JF, Pichot P, The GEP. A double-blind controlled clinical trial of comparing fluvoxamine with imipramine. British Journal of Clinical Pharmacology 15 (Suppl. 3): 411S–417S, 1983
Guillibert E, Pelicier Y, Archambault JP, et al. A double-blind multicentre study of paroxetine versus clomipramine in depressed elderly patients. Acta Psychiatrica Scandinavica 80 (Suppl. 350): 132–134, 1989
Guy W, Wilson WH, Ban TA, King DL, Manov G, et al. A doubleblind clinical trial of fluvoxamine and imipramine in patients with primary depression. Drug Development Research 4: 143–145, 1984
Gwirtsman EE, Guze BH, Yager J, Gainsley B. Fluoxetine treatment of anorexia nervosa: an open clinical trial. Journal of Psychiatry 51: 378–382, 1990
Harris B, Szulecka TK, Anstee JA. Fluvoxamine versus amitriptyline in depressed hospital out-patients: a multicentre double-blind comparative trial. British Journal of Clinical Research 2: 89–99, 1991
Hutchinson DR. A double-blind comparison of paroxetine and amitriptyline in elderly depressed community patients. Abstract, 17th CINP Congress, Kyoto, Japan, 10–14th September, 1990
Itil TM, Shrivastava RK, Mukherjee S, Coleman BS, Michael ST. A double-blind placebo-controlled study of fluvoxamine and imipramine in out-patients with primary depression. British Journal of Clinical Pharmacology 15 (Suppl. 3): 433S–438S, 1983
Jimerson DC, Lesem MD, Kaye WH, et al. Serotonin and symptom severity in eating disorders. Biological Psychiatry 25: 143A, 1989
Kasper S, Dotsch M, Vieira A. Plasma levels of fluvoxamine and maprotiline and clinical response in major depression. Pharmacopsychiatry, in press, 1992
Kasper S, Vol G, Vieira A, Kick H. Response to total sleep deprivation before and during treatment with fluvoxamine or maprotiline in patients with major depression — results of a double-blind study. Pharmacopsychiatry 23: 135–142, 1990
Klok CJ, Brouwer GJ, van Praag HM, Doogan D. Fluvoxamine and clomipramine in depressed patients: a double-blind clinical study. Acta Psychiatrica Scandinavica 64: 1–11, 1981
Laakmann G, Blaschke D, Engel R, Schwarz A. Fluoxetine vs amitriptyline in the treatment of depressed outpatients. British Journal of Psychiatry 153 (Suppl. 3): 64–68, 1988
Laakmann G, Pogelt A, Kriszio B, Breull A, Blaschke D, et al. Behandlungsergebnisse mit Fluoxetin im Vergleich mit Amitriptylin bei ambulanten und stationaren Patienten im Rahmen von Doppelblindstudien (Gesamtanalysen). In Laakmann G (Ed.) Selektive Re-uptake-Hemmung und ihre Bedeutung fur die Depression, pp. 23–43, Springer-Verlag, Berlin, 1991
Lapierre YD, Browne M, Horn E, Oyewumi LK, Sarantidis D, et al. Treatment of major affective disorder with fluvoxamine. Journal of Clinical Psychiatry 48: 65–68, 1987
Levine S, Deo R, Mahadevan K. A comparative trial of a new antidepressant, fluoxetine. British Journal of Psychiatry 150: 653–655, 1987a
Levine LR, Rosenblatt S, Bosomworth J. Use of a serotonin reuptake inhibitor, fluoxetine, in the treatment of obesity. International Journal of Obesity 11: 184–190, 1987b
Maier W, Benkert O. Methodenkritik des Wirksamkeitsnachweises antidepressiver Pharmakotherapie. Nervenarzt 58: 595–602, 1987
March JS, Kobak KA, Jefferson JW, Mazza J, Greist JH. A double-blind placebo-controlled trial of fluvoxamine versus imipramine in outpatients with major depression. Journal of Clinical Psychiatry 51: 200–202, 1990
Mendels J, Fabre L, Kiev A. A double-blind placebo controlled study of citalopram in major depressive disorder. 30th Annual Meeting of New Clinical Drug Evaluation Unit, Florida, May 29–June 1, 1990
Mertens C, Pintens H. Paroxetine in the treatment of depression: a double-blind multicenter study versus mianserin. Acta Psychiatrica Scandinavica 77: 683–688, 1988
Milne RJ, Goa KL. Citalopram. A review of its pharmacodynamic and pharmacokinetic properties, and therapeutic potential in depressive illness. Drugs 41: 450–477, 1991
Möller HJ, Berzewski H, Gonzales N, Eckmann F, Rudolf GAE, et al. A double-blind, multicentre study of paroxetine and amitriptyline in depressed outpatients. Presented at the 5th World Congress of Biological Psychiatry, Florence, June 9–14, 1991
Mullin JM, Pandita-Gunawardena VR, Whitehead AM. A double-blind comparison of fluvoxamine and dothiepin in the treatment of major affective disorder. British Journal of Clinical Practice 42: 51–55, 1988
Murphy JM, Waller MB, Gatto CJ, et al. Effects of fluoxetine on the intragastric self administration of ethanol in the alcohol proferring P line of rats. Alcohol 5: 283–286, 1988
Naranjo CA, Sellers EM. Serotonin uptake inhibitors attenuate ethanol intake in problem drinkers. Developments in Alcoholism 7: 255–266, 1989
Naranjo CA, Sellers EM, Sullivan JT, et al. The serotonin uptake inhibitor citalopram attenuates ethanol intake. Clinical Pharmacology and Therapeutics 41: 266–274, 1987
Nilsson BS. Adverse reactions in connection with zimelidine treatment: a review. Acta Psychiatrica Scandinavica 308: 115–119, 1983
Norden MJ. Fluoxetine in borderline personality disorder. Progress in Neuro-Psychopharmacology and Biological Psychiatry 13: 885–893, 1989
Norton KRW, Sireling LI, Bhat AV, Rao B, Paykel ES. A double-blind comparison of fluvoxamine, imipramine and placebo in depressed patients. Journal of Affective Disorders 7: 297–308, 1984
Ottevanger EA. The efficacy of fluvoxamine in patients with severe depression. British Journal of Clinical Research 2: 125–132, 1991
Perez A, Ashford JJ. A double-blind randomized comparison of fluvoxamine with mianserin in depressive illness. Current Medical Research and Opinion 12: 234–241, 1990
Perse TL, Greist JH, Jefferson JW, et al. Fluvoxamine treatment of obsessive-compulsive disorder. American Journal of Psychiatry 144: 1543–1548, 1987
Peselow ED, Filippi AM, Goodnick P, et al. The short- and long-term efficacy of paroxetine HCI: B. Data from a double-blind crossover study and from a year-long term trial vs imipramine and placebo. Psychopharmacology Bulletin 25: 272–276, 1989
Peters UH, Lenhard P, Metz M. Ambulante antidepressive Therapie. Eine multizentrische Doppelblindstudie. TW Neurologie Psychiatrie 3: 645–650, 1989
Poldinger W, Bures E. Fluvoxamine in patients with depressive disorder. Proceedings of the international symposium on fluvoxamine, pp. 41–44, Duphar Medical Publications, Bern, 1984
Reimherr FW, Byerley WF, Ward MF, Lebegue BJ, Wender PH. Sertraline, a selective inhibitor of serotonin uptake, for the treatment of outpatients with major depressive disorder. Psychopharmacology Bulletin 24: 200–205, 1988
Reimherr FW, Chouinard G, Cohn CK, Cole JO, Itil TM, et al. Antidepressant efficacy of sertraline: a double-blind placebo-and amitriptyline-controlled, multicenter comparison study in outpatients with major depression. Journal of Clinical Psychiatry 51: 18–27, 1990
Reimherr FW, Wood DR, Byerley B, Brainard, Grosser BI. Characteristics of responders to fluoxetine. Psychopharmacology Bulletin 20: 70–72, 1984
Rickels K, Amsterdam J, Clary C, Fox I, Schweizer E, et al. A placebo-controlled, double-blind, clinical trial of paroxetine in depressed outpatients. Acta Psychiatrica Scandinavica 80 (Suppl. 350): 117–123, 1989
Rost W, Schmidtke A, Bauer K, Hubner C, Gattaz WF. Die Wirklatenzhypothese von Antidepressiva: Vergleiiiich zwischen Fluvoxamin und Maprotilin. In Saletu B (Hrsg.) Biologische Psychiatric pp. 158–160, Thieme Verlag, Stuttgart, 1989
Roth D, Mattes J, Sheehan KH, Sheehan DV. A double-blind comparison of fluvoxamine, desipramine and placebo in outpatients with depression. Progress in Neuro-Psychopharmacology and Biological Psychiatry 14: 929–939, 1990
Schalling D. Biochemical correlates of temperament dimensions. Biological Psychiatry 25: 139A–140A, 1989
Shaw DM, Thomas DR, Briscoe MH, Watkins SE, Crimmins R. A comparison of the antidepressant action of citalopram and amitriptyline. British Journal of Psychiatry 149: 515–517, 1986
Shrivastava RK. A double-blind, placebo-controlled study of paroxetine and imipramine in depressed outpatients. Abstract, 17th CINP Congress, Kyoto, Japan, 10–14th September, 1990
Stark P, Hardison CD. A review of multicenter controlled studies of fluoxetine vs imipramine and placebo in outpatients with major depressive disorder. Journal of Clinical Psychiatry 46: 53–58, 1985
Timmerman L, De Beurs P, Tan BK, Leijnse-Ybema H, Sanchez C, et al. A double-blind comparative clinical trial of citalopram versus maprotiline in hospitalized depressed patients. International Journal of Clinical Psychopharmacology 2: 239–253, 1987
Tollefson GD. Serotonin and alcohol interrelationships. 16th collegium internationale neuropsychopharmacologicum congress satellite conference: new findings with anxiolytic drugs, Munich, FRG. Psychopathology 22: 37–48, 1989
Wakelin JS. Fluvoxamine in the treatment of the older depressed patients: double-blind, placebo-controlled data. International Clinical Psychopharmacology 1: 221–230, 1986
Westenberg HJM, den-Boer JA. Clinical and biochemical effects of selective serotonin-uptake inhibitors in anxiety disorders. In Gastpar M, Wakelin JS (Eds) Selective 5-HT reuptake inhibitors: novels or commonplace agents? pp. 84–99, Karger, Basel, 1988
Wurtman JJ. Carbohydrate craving, mood changes, and obesity. Journal of Clinical Psychiatry 49: 37–39, 1989
Young JPR, Coleman A, Lader MH. A controlled comparison of fluoxetine and amitriptyline in depressed outpatients. British Journal of Psychiatry 151: 337–340, 1987
Author information
Authors and Affiliations
Rights and permissions
About this article
Cite this article
Kasper, S., Fuger, J. & Möller, HJ. Comparative Efficacy of Antidepressants. Drugs 43 (Suppl 2), 11–23 (1992). https://doi.org/10.2165/00003495-199200432-00004
Published:
Issue Date:
DOI: https://doi.org/10.2165/00003495-199200432-00004