***TASK*** the task is to summarize an input biomedical literature in six sentences 
    ***INPUT*** the input is a biomedical literature 
    ***OUTPUT*** the output is the summary of an input biomedical literature in six sentences 
    ***DOCUMENTATION*** 
    ***EXAMPLES*** 
    Input: Mild depressive syndromes are highly prevalent among primary -care patients . Evidence -based treatment recommendations need to be derived directly from this diagnostically heterogeneous group . The primary aim was to assess the efficacy of sertraline and cognitive-behavioural group therapy for treatment of depressed primary -care patients , the secondary aim was to evaluate if receiving treatment according to free choice is associated with a better outcome than r and omization to a particular treatment . We conducted a r and omized , placebo-controlled , single-centre , 10-wk trial with five arms : sertraline ( flexible dosages up to 200 mg/d ) ( n = 83 ) ; placebo ( n = 83 ) ; manual-guided cognitive-behavioural group therapy ( one individual session and nine group sessions per 90 min ) ( n = 61 ) ; guided self-help group ( control condition , n = 59 ) ; and treatment with sertraline or cognitive-behavioural group therapy according to patients ' choice ( n = 82 ) . From 1099 consecutively screened adult patients , 368 formed the intent-to-treat population with milder forms of depression . Primary outcome was a global efficacy measure combining z-converted Hamilton Depression Rating Scale and clinician-rated Inventory for Depressive Symptomatology scores .  Sertraline was superior to  placebo  ( p = 0.03 ) . Outcome for guided self-help groups was worse compared to cognitive-behavioural group therapy ( p = 0.002 ) and compared to all other treatment arms including pill placebo ( secondary analyses ) . Outcome in the patients ' choice arm was similar to that in the sertraline and cognitive-behavioural group therapy . Overall , sertraline is efficacious in primary -care patients with milder forms of depression . The superiority of cognitive-behavioural group therapy over guided self-help groups might partly be explained by ' nocebo ' effects of the latter Methods After initial screening and a seven-day washout period , in the case of patients who had received previous antidepressant medication , 47 adult patients who fulfiIled Feighner ’s criteria for the diagnosis of depression ( 1 ) and had a Hamilton Depression Rating Scale ( HAMD ) total score ( 21-item ) of 18 or more were r and omized to treatment with either paroxetine or placebo . The intended duration of double-blind treatment was four weeks . Paroxetine at a single daily dose of 30 mg or matched placebo was administered at night . No concomitant psychotropic medication other than triazolam or flunitrazepam as a hypnotic was permitted . Patients attended for review on days 7,14 , and 28 . The measures of severity of depression were the HAMD scale total score ( 21-item ) , the Beck Depression Inventory ( BDI ) , the Visual Analogue Scale ( VAS ) , and the Clinical Global Impression ( CGI ) of severity of illness . Assessment of tolerability was based on reports of adverse experiences , both spontaneously reported and elicited in response to asideeffect symptom checklist , physical examination , vital signs , and laboratory investigations A controlled double-blind trial of amitriptyline at two dosage levels ( 75 and 150 mg/day ) , amylobarbitone ( 150 mg/day ) , and an inert substance for a period of four weeks was conducted on four matched groups of women attending their general practitioners and suffering from a depressive illness . Improvement at 7 and 28 days was noted on several measures of depression and anxiety in all treatment groups . Of these treatments amitriptyline 150 mg/day was the most consistent in relieving depression and anxiety . Troublesome side effects were equally distributed among the four treatments Escitalopram , a selective serotonin reuptake inhibitor ( SSRI ) , was compared to placebo in a study of patients with major depressive disorder ( DSM-IV ) who had baseline Montgomery – Åsberg Depression Rating Scale ( MADRS ) total scores ≥22 and ≤40 . After a 1-week , single-blind placebo period , patients were r and omized to receive escitalopram 10 mg/day  ( n = 191 ) or placebo  ( n = 189 ) in an 8-week , double-blind period . The primary efficacy analysis of adjusted mean change in MADRS total score from baseline showed a statistically significantly larger effect for escitalopram than for placebo with a treatment difference at week 8 ( last observation carried forward , LOCF ) of 2.7 points ( SE 0.85;P = 0.002 ) . In further by-week efficacy analyses , the effect of escitalopram was consistently larger than that of placebo ( P < 0.05 ) beginning at week 1 ( Clinical Global Impression – Improvement score ) , week 2 ( MADRS score ) or week 3 ( Clinical Global Impression – Severity score ) . Escitalopram was very well tolerated with a low overall withdrawal rate similar to that for placebo . Nausea was the only adverse event reported significantly more in escitalopram-treated patients than in placebo-treated patients , although it was infrequent and transient . Escitalopram 10 mg/day had a statistically significantly better antidepressant effect than placebo as early as week 1 , and was safe and very well tolerated One hundred and fifteen patients from 5 general practice s participated in a 12-week , double-blind study comparing L-tryptophan , amitriptyline , L-tryptophan-amitriptyline combination and placebo in the treatment of depression . Analysis of total score on the Hamilton Depression Scale and a global rating of depression showed that all 3 active treatments were more effective than placebo . Significantly more patients were withdrawn as treatment failures in the placebo group compared with the active treatment groups . Side-effects necessitated withdrawal of more patients from the amitriptyline group than from the other active treatment groups , but this difference was not significant . Plasma amitriptyline and nortriptyline levels were similar in the amitriptyline and combined treatment groups . St and ard haematological and biochemical profiles did not alter significantly in any group , but mean heart rate was significantly increased in patients receiving amitriptyline . There was no change in free or total plasma tryptophan concentration with treatment or on remission of symptoms BACKGROUND Antidepressant prescribing is widespread . Nonetheless , response to antidepressants is variable . If it was possible to predict response to medication and thus tailor treatment accordingly , this would not only improve patient outcomes but may also have economic benefits . AIMS To test the hypothesis that individuals with more severe depression would benefit more from noradrenaline reuptake inhibitors ( NARIs ) than selective serotonin reuptake inhibitors ( SSRIs ) compared with individuals with less severe depression . METHOD Individuals recruited from UK primary care who met ICD-10 criteria for a depressive episode and scored 15 or more on the Beck Depression Inventory ( BDI ) were r and  omised to either an SSRI ( citalopram 20 mg daily ) or a NARI ( reboxetine 4 mg twice daily ) . R and omisation was by means of a remote automated telephone system . The main outcome was depressive symptoms measured by the BDI total score 6 weeks after r and omisation . ( TRIAL REGISTRATION IS RCT N31345163 . ) RESULTS In total , 601 participants were r and omised  ( citalopram : n = 298 , reboxetine : n = 303 ) . Ninety-one per cent were followed up at 6 weeks ( citalopram : n = 274 , reboxetine : n = 272 ) . There was little evidence to support an interaction between treatment and severity of depression ( interaction term : 0.02 , 95 % CI -0.59 to 0.62 , P = 0.96 ) . Adjustment for potential confounders ( age , gender , employment status , history of depression , number of life events and social support ) did not affect the findings ( interaction term : 0.06 , 95 % CI -0.54 to 0.66 , P = 0.85 ) . CONCLUSIONS Treatment with NARIs does not confer any advantage over SSRI treatment for outcome in those with more severe depressive illness presenting in primary care BACKGROUND Although some depression trials have included quality of life ( QoL ) as an outcome measure , assessment s were retrospective and relatively infrequent . Because QoL varies in relation to everyday experience , intensive time-sampling approaches may be useful . METHOD The experience sampling method ( ESM ) was used to assess effects of antidepressant treatment on the quality of life , as measured from moment to moment in daily life ( mQoL ) , and related aspects of daily experience . Primary care patients with a DSM-III-R/DSM-IV diagnosis of major depressive disorder were r and omly assigned to imipramine ( N = 32 ) or placebo ( N = 31 ) treatment for 6 weeks , with possible prolongation to 18 weeks . A healthy control group ( N = 22 ) provided normative data . RESULTS Treatment-related increases in frequency and severity of physical complaints , including those not reported to the general practitioner as side effects , were associated with lowered mQoL ; this negative association was especially strong in treatment dropouts . Despite greater clinical improvement at week 6 , imipramine patients did not report greater increases than placebo patients in mean mQoL ratings . However , imipramine treatment stabilized mQoL fluctuations and led to reductions in time spent " doing nothing . " Patients ' decisions to prolong treatment depended on clinical improvement , mQoL changes , and specific early side effects . At 18 weeks , remitted patients still showed deficits on ESM daily life measures relative to healthy controls , even though QoL had returned to normal on retrospective measures . CONCLUSION ESM provides new insights in the effects of antidepressant treatment on daily life experiences and should therefore be considered as a supplement to conventional instruments in clinical trials Abstract Objective : To evaluate the efficacy of emotional support and counselling combined with placebo or antidepressants with single or dual mechanism of action in the treatment of depression in primary care . Design : R and omised double blind study . Setting : Several locations in Norway . Subjects : 372 patients with depression . Main outcome measures : Improvement ( clinical remission ) reported both by the patient ( Montgomery Åsberg depression rating scale ) and the physician ( clinical global improvement and impression scales ) . Results : Intention to treat analyses showed 47 % remission in patients r and omised to placebo compared with 61 % remission in patients r and omised to sertraline ( odds ratio 0.56 , 95 % confidence interval 0.33 to 0.96 ) and 54 % in patients r and omised to mianserin ( 0.75 , 0.44 to 1.27 ) . Women responded  better than men ( 1.86 , 1.17 to 2.96 ) . Subgroup analyses showed that subjects with recurrent depression ( n=273 ) responded more frequently to sertraline than to placebo ( 0.43 , 0.23 to 0.82 ) than those having their first episode of depression ( 1.18 , 0.39 to 3.61 ) . Statistically significant interactions between type of drug treatment and history of depression were not shown by logistic regression . Conclusion : The combination of active drug and simple psychological treatment ( counselling , emotional support , and close follow up over a 24 week period ) was more effective than simple psychological treatment alone , in particular for those with recurrent depression . Overall , women may benefit more than men . If confirmed in future studies , the findings should lead to more differentiated treatment guidelines for depression in primary care A double‐blind , placebo‐controlled study of 229 patients with a Research Diagnostic Criteria diagnosis of major , minor or intermittent depression was used to compare the clinical profiles of venlafaxine and imipramine in general practice . Venlafaxine produced a significant improvement compared to placebo in symptoms of depression and anxiety as rated by the total MADRS and percentage of responders , the CGI improvement , the CGI severity of illness , the BSA psychic anxiety item and the HSCL . On a number of these measures , venlafaxine was also significantly more effective than imipramine . Venlafaxine was significantly superior to both imipramine and placebo for the SARS total score and the items ' socialeisure ’ and ‘ extended family.’A similar proportion of patients discontinued treatment in each group , but fewer patients on venlafaxine discontinued treatment because of an unsatisfactory response Escitalopram is the active S-enantiomer of citalopram . In a chronic mild stress model of depression in rats , treatments with both escitalopram and citalopram were effective ; however , a faster time to onset of efficacy compared to vehicle treatment was observed for escitalopram-treated ( 5 mg/kg/day ) than for citalopram-treated ( 10 mg/kg/day ) rats at Week 1 . To study the predictability of this observation in the clinic , we analysed 4-week data from an 8-week , double-blind , r and omised , placebo-controlled , flexible-dose study that compared escitalopram and citalopram to placebo in primary care patients with major depressive disorder ( baseline Montgomery and Asberg Depression Rating Scale ( MADRS ) scores > or = 22 and < or = 40 ) . Since the flexible dosing started after Week 4 , analysis of 4-week data ensured that the patients received fixed doses of 10 mg/day escitalopram ( 155 patients ) , 20 mg/day c 
    Output:
    
There was evidence of publication bias .
Antidepressants such as TCA , SSRI , SNRI ( serotonin-norepinephrine reuptake inhibitor ) and NaSSA ( noradrenergic and specific serotonergic antidepressant ) classes appear to be effective in primary care when compared with placebo .
However , in view of the potential for publication bias and that only four studies were not funded by industry , caution is needed when considering their use in primary care