Paroxetine in the treatment of dysthymic disorder without co-morbidities: A double-blind, placebo-controlled, flexible-dose study

Selective serotonin reuptake inhibitors and quality of life: a meta-analysis of randomized placebo-controlled trials

The benefit of selective serotonin reuptake inhibitors (SSRIs) in improving quality of life (QoL) has been investigated in randomized-controlled trials (RCTs) with equivocal results. This study explored whether SSRIs could improve QoL in individuals with medical, psychiatric, and neuropsychiatric conditions. RCTs were searched in PubMed, Embase, Scopus, Ovid, and Google Scholar. Data were synthesized via a meta-analysis. Subgroup and meta-regression analyses were performed. The sample size was 9,070. Compared with placebo, SSRIs showed statistically significant improvements in QoL in cancer (d = 0.30), major depressive disorder (d = 0.27), premenstrual dysphoric disorder (d = 0.38), type 2 diabetes mellitus (d = 0.48), persistent depressive disorder (d = 0.32), and menopausal symptoms (d = 0.40). Paroxetine exhibited the highest effect size. No significant improvements were noted in chronic obstructive pulmonary disease (d = 0.65, P = 0.09), congestive heart failure (d = 0.46, P = 0.27), and irritable bowel syndrome (d = 0.26, P = 0.127). The reduction in depressive symptoms improved QoL. Small-study effects, high attrition rates, and demographic imbalances are limiting factors to recommend SSRIs to improve QoL. Future research should focus on QoL domains and pharmacological properties of each SSRI.

Challenges in the treatment of dysthymia: a narrative review

INTRODUCTION

Despite its milder severity, the chronic nature of dysthymia leads to significant impairments and functional limitations. The treatment of dysthymia has received considerably less research attention compared to major depressive disorder (MDD).

AREAS COVERED

The authors have conducted a comprehensive review on the treatment of dysthymia. Their primary objective was to identify therapeutic options that have demonstrated genuine efficacy. To do this, they searched the PubMed database, without any time restrictions, to retrieve original studies. The samples were exclusively comprised individuals diagnosed with dysthymia according to the diagnostic criteria outlined in DSM-III, DSM-III-R, DSM-IV, or DSM-IV-TR.

EXPERT OPINION

Within the realm of dysthymia treatment, several antidepressants, including imipramine, sertraline, paroxetine, minaprine, moclobemide, and amineptine, in addition to the antipsychotic agent amisulpride, have demonstrated superiority over placebo. In certain studies, psychotherapeutic interventions did not distinguish themselves significantly from pharmacological treatments and failed to exhibit greater efficacy than a placebo. However, these findings remain inconclusive due to the limited number of studies and substantial methodological limitations prevalent in a significant proportion of them. Limitations include factors like small sample sizes, the absence of placebo comparisons, and a lack of study blinding.

An update on the pharmacotherapeutic strategies for the treatment of dysthymic disorder: a systematic review

INTRODUCTION

Longer treatment times, more comorbidity, more severe impairments in social, psychological, and emotional functioning, increased healthcare use, and more hospitalizations are all factors that are related to dysthymia. Given the significant prevalence of dysthymia (including persistent depressive disorder) worldwide, its comorbidity with several mental disorders, and the detrimental effects of these comorbidities, it is important to conduct a systematic review to compare the effects of pharmacological acute and maintenance treatments for dysthymia with placebo and standard care in the last 10 years, based on the publication of DSM5.

AREAS COVERED

This systematic review was performed according to PRISMA guidelines. Databases, including PubMed and Cochrane Central Register of Controlled Trials, were searched to assess the effects of pharmacological acute and maintenance treatments for dysthymia in comparison with placebo and treatment as usual.

EXPERT OPINION

Our review shows that SSRIs and SNRIs present efficacy for dysthymia treatment, and L-Acetylcarnitine should be investigated further for this condition in elderly patients. The comparison of antidepressant medication versus placebo showed coherent results based on three studies favoring pharmacotherapy as an effective treatment for participants with dysthymia. However, the scarcity of research on continuation and maintenance therapy in people with dysthymia highlights the need for more primary research.

Placebo and nocebo reactions in randomized trials of pharmacological treatments for persistent depressive disorder. A meta-regression analysis

BACKGROUND

We aimed to investigate placebo and nocebo reactions in randomized controlled trials (RCT) of pharmacological treatments for persistent depressive disorder (PDD).

METHODS

We conducted a systematic electronic search and included RCTs investigating antidepressants for the treatment of PDD. Outcomes were the number of patients experiencing response and remission in placebo arms (=placebo reaction). Additional outcomes were the incidence of patients experiencing adverse events and related discontinuations in placebo arms (=nocebo reaction). A priori defined effect modifiers were analyzed using a series of meta-regression analyses.

RESULTS

Twenty-three trials were included in the analyses. We found a pooled placebo response rate of 31% and a placebo remission rate of 22%. The pooled adverse event rate and related discontinuations were 57% and 4%, respectively. All placebo arm outcomes were positively associated with the corresponding medication arm outcomes. Placebo response rate was associated with a greater proportion of patients with early onset depression, a smaller chance to receive placebo and a larger sample size. The adverse event rate in placebo arms was associated with a greater proportion of patients with early onset depression, a smaller proportion of females and a more recent publication.

CONCLUSIONS

Pooled placebo and nocebo reaction rates in PDD were comparable to those in episodic depression. The identified effect modifiers should be considered to assess unbiased effects in RCTs, to influence placebo and nocebo reactions in practice.

LIMITATIONS

Limitations result from the methodology applied, the fact that we conducted only univariate analyses, and the number and quality of included trials.

Odds ratios of treatment response were well approximated from continuous rating scale scores for meta-analysis

OBJECTIVES

To empirically evaluate the performance of methods for estimating odds ratios and their corresponding standard errors from continuous end point data for meta-analysis.

STUDY DESIGN AND SETTING

A database of randomized controlled trials of chronic depression treatments was used. Trials that reported both continuous and dichotomous end points for symptom improvement were considered. Odds ratios and standard errors were calculated from the dichotomous data and estimated from the continuous data using currently available methods: Hasselblad and Hedges (HH), Cox and Snell (CS), Furukawa (F), Suissa (S), and Kraemer and Kupfer (KK). Single and meta-analytically pooled observed and estimated values were compared.

RESULTS

A total of 26 trials were included. At the trial level, four of five (HH, CS, F, and S) and three of four (HH, F, and S) methods for estimating odds ratios and standard errors performed well, respectively. We found considerable differences in the performance of all methods across trials with more accurate estimates for smaller treatment effects. At the level of meta-analysis, three of four methods (CS, F, and S) performed acceptably.

CONCLUSION

Odds ratios and standard errors can be approximated from continuous end points, but we recommend sensitivity and subgroup analyses to test robustness of the findings.

The re-labelling of dysthymic disorder to persistent depressive disorder in DSM-5: old wine in new bottles?

PURPOSE OF REVIEW

Dysthymic disorder and other chronic depressive disorders have recently been merged in DSM-5 into a 'persistent depressive disorder' category. As its introduction in DSM-III, the validity of dysthymic disorder has long been challenged, posing concerns regarding the validity of its successor--persistent depressive disorder. This review aims to present recent findings regarding the validity and utility of dysthymic disorder.

RECENT FINDINGS

Several recent studies raise questions regarding the validity of dysthymic disorder, namely, results indicating a significant overlap between dysthymic disorder and other mood and/or anxiety disorders, failure of such a diagnosis to predict illness outcome and the lack of any validation strategy identifying that it is a depressive entity or subtype.

SUMMARY

Research findings indicate that dysthymic disorder is a heterogeneous diagnosis encompassing many different depressive (and anxiety or personality weighted) conditions, and without clear evidence of its validity as a diagnostic entity. As dysthymic disorder is a key component of DSM-defined persistent depressive disorder--the latter is at similar risk of providing a heterogeneous domain diagnosis, and thus limiting identification of specific causative factors and preferential treatment modality.