Clinical lore has it that SSRIs are preferable to bupropion for depressed patients who present with anxiety and insomnia. Papakostas and colleagues tested this assumption by obtaining patient data from 10 studies funded by GlaxoSmithKline (makers of brand name Wellbutrin) over the years. Analyzing results involving 2122 patients with major depression, the authors found no differences in overall efficacy between the two classes, with the exception of a marginal advantage in the Hamilton Anxiety Scale for women, but not men. How marginal was the benefit? The SSRI anxiety scale response rate was 63.8% vs. bupropion’s 58.8%. Since the authors reviewed 64 different outcome measures, this difference was highly likely to occur by chance alone (Papakostas GI, et al., Int Clin Psychopharmacology July 2007;22(4):226-229.)
TCPR’s Take: While this data implies that Wellbutrin is just as effective for anxious depression as the SSRIs, all of the trials were sponsored by GSK, meaning that they were presumably designed in order to make bupropion look good. The authors did not discuss this possibility, presumably because they all have dozens of industry relationships and because two of the authors are GSK employees.
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