[Low dosages of tricyclic antidepressants].
In a meta-analysis of 39 controlled studies, tricyclic antidepressants (TCAs) were found to be effective in the treatment of depressive disorders at dosages under 100 mg/day. No advantage was found for the generally recommended higher dosages. However, the authors ofthe analysis did not pay attention to the problems of diagnostic and therapeutic heterogeneity in the studies that were included. After a closer look, it seems plausible that TCAs do have an effect at lower dosages. Due to the diagnostic heterogeneity, however, it remains unclear whether the effect is on the core symptoms of depressive disorders or rather on symptoms such as anxiety, pain or sleep disorders. Due to the therapeutic heterogeneity, no claims with regard to the effectiveness of lower dosages are justified. The meta-analysis provides no reason to adjust the current guidelines for the dosage of TCAs in the treatment of depressive disorders.
van Hemert
A M
AM
Parnassia Psycho-medisch Centrum, Bureau 24-uurszorg, Avocadostraat 2, 2552 HS Den Haag.
Birkenhäger
T K
TK
D000929:Antidepressive Agents, Tricyclic / Q000008:administration & dosage / Q000627:therapeutic use*; D003866:Depressive Disorder / Q000188:drug therapy*; D004305:Dose-Response Relationship, Drug; D006801:Humans; D015201:Meta-Analysis as Topic; D016896:Treatment Outcome
D000929:Antidepressive Agents, Tricyclic