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Zimelidine and amitriptyline in the treatment of depressive illness in general practice
Insights
This study compared zimelidine and amitriptyline for depression treatment in general practice. Both antidepressants showed similar effectiveness, though zimelidine caused weight loss and fewer side effects than amitriptyline.
Area of Science:
- Psychiatry
- Clinical Pharmacology
Background:
- Depressive patients in hospital clinics may not represent those treated in general practice.
- Specialist assessment in general practitioners' surgeries offers a more representative patient sample.
Purpose of the Study:
- To compare the treatment response and side effects of zimelidine and amitriptyline in patients receiving antidepressant treatment in general practice.
- To assess if patient selection in general practice influences treatment outcomes.
Main Methods:
- Patients meeting Research Diagnostic Criteria for major/minor depression with a Hamilton Depression (Ham-D) score ≥10 were included.
- Weekly assessments included Ham-D, Kellner Sheffield Self-Rating test (KSSRT), and side effect checklists.
- Random, double-blind allocation to identical zimelidine (100-200 mg/day) or amitriptyline (75-150 mg/day) for four weeks.
Main Results:
- No significant difference in improvement between zimelidine and amitriptyline on Ham-D or KSSRT scores at four weeks.
- Amitriptyline group showed weight gain, while the zimelidine group showed weight loss (significant difference).
- Zimelidine was associated with fewer side effects compared to amitriptyline, with diarrhoea being a notable side effect for zimelidine.
Conclusions:
- Zimelidine and amitriptyline demonstrate comparable efficacy in treating depression in a general practice setting.
- Zimelidine presents a potentially favorable side effect profile, including weight loss and reduced adverse events compared to amitriptyline.
- Further research is needed to explore the relationship between plasma levels and clinical response.
Abstract:
Depressive patients seen at hospital clinics are likely to be unrepresentative in terms of treatment response. In this study patients were always seen at their general practitioners' surgeries for assessment by specialists after selection as being in need of antidepressant treatment. The Research Diagnostic Criteria for major or minor depressive illness and a Hamilton Depression (Ham-D) score of at least 10 were required for inclusion, using the Present State Examination as a basis for interview. Patients were seen at weekly intervals, alternatively by practitioner and assessor for further Ham-D ratings, completion of the Kellner Sheffield Self-Rating test (KSSRT), event record and side effect checklist. Patients were randomly and blindly allocated to either zimelidine or amitriptyline dispensed identically at dosages of 100 mg and 75 mg at night, rising to 200 mg and 150 mg after two weeks. At four weeks there was no significant difference between the improvement found with zimelidine and amitriptyline or either the Ham-D or the KSSRT. Amitriptyline patients tended to gain and zimelidine patients to lose weight; difference significant. Other amitriptyline side effects were not found in those taking zimelidine, the latter tending to suffer diarrhoea. Preliminary analysis shows no relationship between clinical response and plasma level of either compound.