Last year, we reviewed a meta-analysis implying that bupropion is as effective as SSRIs for the treatment of patients with mixed anxi- ety and depression (TCPR, Aug 2007). In a new paper, these same researchers have sliced and diced the data a bit differently in order to answer this topic more confidently. Inapooledanalysisof10tri- als, researchers found that patients with anxious depression had a higher response rate when taking an SSRI as opposed to bupropion for both depression (65.4% vs. 59.4%) and anxiety (61.5% vs. 54.5%), as measured by the Hamilton Rating Scale for Depression (HAM-D) and the Hamilton Rating Scale for Anxiety (HAM-A). These differences were statistically significant. There was also a statistically significant, but very small, difference favoring SSRIs over bupropion on the mean HAM-D score. For nonanxious depression, there were no differences in treatment outcomes between patients taking bupropion and those taking SSRIs. (Papakostas GI et al., J Clin Psychiatry; Published online ahead of print).
TCPR’sTake: Foranxiousdepression,thisisthelargestcom- parisonbetweenbupropionandSSRIs. Theclinicalrelevanceof the results is certainly questionable, as the average patient taking an SSRI fared less than a single point better on the HAM-D relative to the average patient taking bupropion. There were no differences between SSRI and bupropion in terms of remission rates for depressionoranxiety. Basedonthesefindings,SSRIsappearto possess, at most, a very slight advantage over bupropion for anx- iousdepression. Alltrialsincludedintheanalysisweresponsored by GlaxoSmithKline, manufacturer of bupropion.
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