Date: 7/4/2016 By: Mahmoud Mostafa

1. Date: 7/4/2016 By: Mahmoud Mostafa

2. Choosing an Anti-depressant • Considering drug profile. • Considering patient profile.

3. Considering drug profile • Efficacy of drug in treating the condition both acute & long term. • Efficacy in treating any co-morbid conditions eg: anxiety ,panic….etc. • Tolerability of the drug. • Safety in overdose.

4. Cipriani Et Al • Independently funded meta-analysis that compared the efficacy and patient acceptability of 12 antidepressants • 117 randomised clinical trials (25 928 participants) from 1991 - 30th Nov. 2007 • Included bupropion, citalopram, duloxetine, escitalopram, fluoxetine, fluvoxamine, milnacipran, mirtazapine, paroxetine, reboxetine, sertraline and venlafaxine Cipriani et al. Lancet 2009; 373 (9665): 746–758

5. Cipriani Et al Cont. • Only assessed the acute treatment phase (first 8 weeks of treatment) in adults with unipolar major depressive disorder • Side-effects, toxic effects, discontinuation symptoms, social functioning and cost-effectiveness were not considered • Fluoxetine was used as the reference drug Cipriani et al. Lancet 2009; 373 (9665): 746–758

6. Primary outcome measures • Response (proportion of patients who had a reduction of at least 50% from baseline on • Hamilton depression rating scale or • Montgomery-Åsberg depression rating scale or • Who scored much improved or very much improved on the clinical global impression at 8 weeks) • Acceptability (number of patients who terminated the study early for any reason during the first 8 weeks) Cipriani et al. Lancet 2009; 373 (9665): 746–758

8. Acceptability also differs between antidepressants Adapted from Cipriani et al. Lancet 2009; 373 (9665): 746–758(Source: Patrick et al. J Fam Pract 2009; 58 (7): 365–369) OR=odds ratio, using fluoxetine as the reference medication

11. Thank You