Low dosage tricyclic antidepressants in depression

doi:10.1136/bmj.326.7387.499/a

BMJ 2003;326:499 ( 1 March )

Letters

Low dosage tricyclic antidepressants in depression

Giving low dose tricyclics is not justified by evidence

Evidence to change current guidelines is insufficient

Non-superiority does not equal equivalence

Authors' reply

Giving low dose tricyclics is not justified by evidence

The first 150 words of the full text of this article appear below.

EDITOR $---$ The meta-analysis by Furakawa et al must be considered downright naughty.¹ While masquerading as a contributionto an academic debate about appropriate antidepressant treatmentit actually does little more than endorse the widely held prejudicein favour of using low dose tricyclics in depression. Publishedin a widely read UK general medical journal, it will inevitablyencourage a practice that is not encouraged by either the RoyalCollege of Psychiatrists or the American PsychiatricAssociation.

The subject of optimal dosage of tricyclics remains controversial, but the value of treatment with tricyclic antidepressantsat standard dosage compared with placebo is abundantly clear.As Furakawa et al concede but perhaps do not emphasise sufficiently,the evidence for low dose tricyclic antidepressants is of generallypoor quality. Many of the trials used in their analysis took placebefore standardised diagnostic or outcome criteria werecommonplace.

What is less clear is the . . . [Full text of this article]

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Meta-analysis of effects and side effects of low dosage tricyclic antidepressants in depression: systematic review: Toshi A Furukawa, Hugh McGuire, and Corrado Barbui
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