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Home » SSRIs show weak advantage over bupropion for anxious depression

SSRIs show weak advantage over bupropion for anxious depression

July 1, 2008
From The Carlat Psychiatry Report
Issue Links: Learning Objectives | Editorial Information | PDF of Issue
Mark Zimmerman, MD

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.

General Psychiatry
KEYWORDS depressive_disorder
    www.thecarlatreport.com
    Issue Date: July 1, 2008
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    Table Of Contents
    Antidepressants and Bipolar Disorder: An Update
    Lamictal: What is it Good For?
    Weight Gain and Mood Stabilizers
    The Case in Favor of the Bipolar Spectrum
    Is Bipolar Disorder Overdiagnosed?
    SSRIs show weak advantage over bupropion for anxious depression
    Computer as psychotherapist?
    The History of Depakote
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