The treatment of severe depression: is there an efficacy gap between SSRI and TCA antidepressant generations?
BACKGROUND
Depression is classified along a spectrum of severity that may have implications for treatment. Since the newer generation of serotonin selective reuptake inhibitors (SSRIs) has, for the most part, displaced the older tricyclic antidepressants (TCAs) as first-line treatment, the efficacy of the SSRIs compared with the TCAs for severe depressions has been questioned.


METHODS
I reviewed all available English-language literature in the MEDLINE data base that compared the SSRIs with the TCAs, especially those studies on severe depression.


RESULTS
Most of the studies that explored the efficacy of the SSRIs, as compared with the TCAs, for severe depression found that these two classes of antidepressants were equivalent. Nevertheless, only a few studies actually studied severely depressed inpatients.


CONCLUSIONS
The data suggest that the SSRIs are just as effective as the TCAs for severe depressions.
Nierenberg
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AA
Depression Research Program, Massachusetts General Hospital, Boston.
D000553:Ambulatory Care; D000929:Antidepressive Agents, Tricyclic / Q000627:therapeutic use*; D002986:Clinical Trials as Topic; D003866:Depressive Disorder / Q000188:drug therapy* / Q000523:psychology; D006760:Hospitalization; D006801:Humans; D010919:Placebos; D011569:Psychiatric Status Rating Scales; D017367:Selective Serotonin Reuptake Inhibitors / Q000627:therapeutic use*; D012720:Severity of Illness Index; D016896:Treatment Outcome
D000929:Antidepressive Agents, Tricyclic; D010919:Placebos; D017367:Selective Serotonin Reuptake Inhibitors