***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: A multi-centre general practice study was carried out to compare flupenthixol and a sustained-release preparation of amitriptyline in the primary care treatment of depression in the elderly . Fifty-one clinical ly depressed patients , aged 65 years or over , were allocated at r and om to one of the two treatment groups in this 4-week double-blind , double-dummy study . On entry , patients received either a 0.5 mg flupenthixol tablet in the morning and a placebo capsule at night ( 25 patients ) or a 25 mg sustained-release amitriptyline capsule at night and a placebo tablet in the morning ( 26 patients ) , but at the end of the first or second weeks the dosage could be doubled according to the assessed clinical need . Fourteen patients in each treatment group had their dosages doubled . Patient assessment was undertaken on study entry and after 1 , 2 and 4 weeks of treatment using a 0 to 3 scale global assessment and the Montgomery Asberg Depression Rating Scale ; side-effects were recorded on the UKU Scale . After 4-weeks ' treatment , over 80 % of patients in each group had improved and in the flupenthixol group there was additionally a noticeable and highly significant reduction in symptom severity after only 1 week of treatment . Patients treated with flupenthixol had fewer and milder side-effects In a double-blind , 4-week , prospect i ve , r and omized multicenter ( 17 centers ) study we checked on the efficacy , tolerability and safety of moclobemide ( 300 - 600 mg/d ) compared to imipramine ( 100 - 200 mg/d ) in parallel groups of patients with a Major Depressive Episode ( DSM III ) . The mean % reduction of the HAMD at the end of treatment was 51.7 in the moclobemide group and 52.1 in the imipramine group . The percentage of patients in whom efficacy was globally judged as " good " or " very good " was 62 % in the moclobemide group and 60 % in the imipramine group . There was no statistically significant difference in the efficacy in both groups but in some factors there was a trend for a better amelioration favoring moclobemide . The final overall physician 's judgement of tolerability was " good " or " very good " in 83 % of moclobemide patients and in 74 % of imipramine patients . Adverse events were reported or observed in 56 % of moclobemide patients and in 69 % of imipramine patients . The number of mild , moderate and severe adverse events was higher in the  imipramine group with a total of 286 versus 189 . There was a statistically high significant difference considering the tolerability favoring moclobemide again . In this project the basic goal to find a substance with at least the same efficacy but a much better tolerability for sure got fulfilled Seventy-five patients , 55 years or older , were treated for major depression with either nortriptyline , phenelzine , or placebo during a 7-week period . There was a significantly greater mean orthostatic fall in systolic pressure in patients treated with nortriptyline and phenelzine as compared to the placebo group , but no significant difference was evident between the nortriptyline and phenelzine groups . The orthostatic changes appeared during the first week of treatment and were not correlated with plasma level of nortriptyline , percent platelet monoamine oxidase inhibition , or pretreatment orthostatic changes A comparative age-associated study of the efficacy and side effects of amitriptyline and maprotyline was carried out in a group of 93 patients over 50 . The health status of the patients was assessed with the aid of Hamilton 's depression scale and the scale of side effects on days 0 , 7 and 28 of the therapy . It has been discovered that on day 28 maprotyline caused a more complete reduction of depressive disorders as compared to amitriptyline . Maprotyline produced a more intensive action on the anxious component of depression . There were differences in the intensity and range of side effects evoked by amitriptyline and maprotyline . Unlike maprotyline , the antidepressive effect of amitriptyline developed in a group of patients over 70 , at later stages of the therapy . Therefore , it is more advisable that tetracyclic antidepressants be used for the treatment of senile patients Selective serotonin reuptake inhibitors ( SSRIs ) have been reported to be useful in the treatment of  depression in patients with Parkinson 's disease ( PD ) . However , a few reports have suggested that SSRIs may worsen parkinsonian motor symptomatology and extrapyramidal side effects have been reported in depressed patients treated with SSRIs . So far , no prospect i ve trial comparing the effects of different SSRIs in depressed patients with PD has been performed . The aim of the present study was to assess the effects of four SSRIs ( citalopram , fluoxetine , fluvoxamine , and sertraline ) on motor performance and their efficacy on depression in a group of patients with PD . Sixty-two consecutive nondemented , nonfluctuating , depressed patients with PD were included in four treatment groups ( 15 patiens received citalopram , 16 fluoxetine , 16 fluvoxamine , and 15 sertraline ) . The evaluation of extrapyramidal and depressive symptomatology was performed with use of the Unified Parkinson 's Disease Rating Scale ( UPDRS ) , Beck Depression Inventory , and Hamilton Depression Rating Scale at baseline and after 1 , 3 , and 6 months . Fifty-two patients completed the study .  UPDRS scores were not significantly modified by the add-on therapy with each of the SSRIs studied . A significant improvement in depressive symptoms from baseline to the end of the trial was obtained with all SSRIs ( Beck and Hamilton scores improving;p < 0.05 according to an analysis of variance ) . Our findings suggest that SSRIs do not significantly worsen extrapyramidal symptomatology and may ameliorate depression in patients with PD There is a rather limited data base of controlled clinical trials on the comparative effects of antidepressants in elderly and non-elderly depressed patients . A common finding is reduced efficacy and an increased incidence of side effects . To further examine the question of efficacy and safety of antidepressant drugs in elderly versus non-elderly patients , the differential effects of a new selective type A monoamine oxidase inhibitor brofaromine , and the classical tricyclic imipramine were investigated using the data of two recently published trials . We found no major difference between non-elderly and elderly depressed patients as concerns efficacy , total incidence of adverse findings or safety parameters such as laboratory values and heart rate . These results are discussed in the light of some method ological questions and previous reports BACKGROUND Depression in older people is often unrecognised and untreated or under-treated . Antidepressant treatment may itself exacerbate a pre-existing illness , interact with concomitant medications or produce undesirable cognitive and sedative side effects . Newer antidepressants may offer advantages in terms of a lesser burden of adverse effects . METHODS The comparative tolerability of the unique selective noradrenaline reuptake inhibitor ( selective NRI ) reboxetine ( 4 - 6 mg/day ; n = 176 ) and that of imipramine ( 50 - 100 mg/day ; n = 171 ) was assessed in an elderly ( > 65 years ) cohort of depressed or dysthymic patients in an 8-week , double-blind , multicentre trial . Comparative efficacy was also assessed . RESULTS Overall , 68 % of patients in the reboxetine group experienced adverse events compared with 71 % in the imipramine group . Reboxetine-treated patients were less likely to develop hypotension and related symptoms ( 7 % vs. imipramine 16 % ) or cardiovascular disorders ( 12.5 % vs. imipramine 21.1 % ) , while those treated with imipramine were less likely to experience insomnia ( 6.3 % vs. 2.9 % ) . Adverse events were more often assessed as related to treatment ( 43 % ) and moderate to severe in intensity ( 73 % ) with imipramine than with reboxetine ( 33 % and 65 % , respectively ) . Furthermore , there were fewer serious adverse events in the reboxetine-treated group ( P = 0.019 ) . The reduction in the Hamilton Rating Scale for Depression ( HAM-D ) was comparable between the treatment groups in the total population . At the last assessment , the majority of patients in both treatment groups were assessed as normal to borderline or mildly ill using the Clinical Global Impression ( CGI ) scale . In a sub analysis of the dysthymic patients a modest but significant difference in favour of imipramine was observed for both HAM-D and CGI assessment s. This may have been a reflection of a trend towards more severe depressive symptoms at baseline in the reboxetine group . CONCLUSIONS Reboxetine is as effective as imipramine in the treatment of depression in elderly patients but is at least as well tolerated with a lower risk of hypotension and related symptoms , fewer serious adverse events , adverse event-related withdrawals and treatment-related adverse events The efficacy and safety of alprazolam as compared to imipramine or a placebo added to weekly interpersonal psychotherapy was compared in a 6-week double-blind r and omized clinical trial of 35 ambulatory elderly patients with major depression . The average maximum dosage of alprazolam was 2.2 mg and the average maximum dosage of imipramine was 97.5 mg . The findings showed a rapid onset of action of alprazolam within 1 week on symptoms of depression and anxiety . The effects for imipramine were seen later in the study . There were no serious side effects that interfered with treatment . The anticholinergic effects of imipramine were the ones that most commonly interfered with treatment . Alprazolam produced the greatest number of symptoms with discontinuation , most of which were alleviated within a week . We conclude that alprazolam may be useful as an antidepressant for the elderly . More clinical trials are needed to test its efficacy in the depressed elderly with concomitant medical problems , using plasma levels . A double-blind discontinuation study of alprazolam is needed to determine the degree of symptom return OBJECTIVE The popularity of selective serotonin reuptake inhibitors stems from their apparent efficacy for numerous disorders and their favorable side effect profile . However , several studies have suggested that selective serotonin reuptake inhibitors may be relatively ineffective for treating melancholia . The objective of this study was to compare the responses to fluoxetine and nortriptyline of older patients with both severe depression and heart disease . METHOD The outcome of 22 hospitalized patients with unipolar depression and heart disease who were treated with fluoxetine was compared to the outcome of 42 comparable patients treated with nortriptyline . The average age of the fluoxetine group was 73 years , and their mean pretreatment score on the Hamilton Depression Rating Scale was 26 ; the average age of the nortriptyline group was 70 , and their mean pretreatment Hamilton score was 28 . RESULTS Of the 42 nortriptyline-treated patients , 28 were responders , six were nonresponders , and eight dropped out . The intent-to-treat response rate was 67 % ( 28 of 42 ) , and the response rate of the melancholic patients who completed the nortriptyline trial was 83 % ( 20 of 24 ) . Of the 22 fluoxetine-treated patients , five were responders , 13 were nonresponders , and four dropped out . The intent-to-treat response rate was 23 % ( five of 22 ) , and the response rate of the melancholic patients who completed the fluoxetine trial was 10 % ( one of 10 ) . CONCLUSIONS Fluoxetine appears to be significantly less effective than nortriptyline for treating hospitalized elderly patients with unipolar major affective disorder , especially those with the melancholic subtype and concurrent cardiovascular disease Seventy five elderly depressed in- patients , ages ranging from 60 to 83 years , diagnosed as Major Depression according to DSM III were treated , under double-blind conditions , with 75 mg Amitriptyline ( AMI ) ( 26 patients ) , 60 mg Mianserin ( MIA ) ( 24 patients ) or 150 mg Trazodone ( TRZ ) ( 25 patients ) p.o . for 5 weeks . There were no differences in the clinical outcome between the three groups of patients at the end of the trial , with a significant amelioration ( P<0.01 ) at the Hamilton Rating Scale for Depression and Geriatric Depression Scale .  TRZ showed a significantly lower incidence of side effects compared to MIA and AMI . Atypical antidepressants , including TRZ , seem more suitable for treating elderly depression than the first generation antidepressants on the basis of risk/benefit ratio considerations Steady-state plasma levels of mianserin , amitriptyline , and nortriptyline were determined by HPLC in two groups of elderly depressed patients who underwent a 5-week treatment with mianserin ( 60 mg/day in three oral doses ) or amitriptyline ( 75 mg/day in three oral doses ) . Both treatments proved to be effective in reducing depressive symptoms . In the mianserin group , responder patients had steady 
    Output:
    
We were unable to find any differences in efficacy when comparing classes of antidepressants .
The qualitative analysis of side effects showed a small increased profile of gastro-intestinal and neuropsychiatric side effects associated with classical TCAs .
Our findings suggest that SSRIs and TCAs are of the same efficacy .
However , we have found some evidence suggesting that TCA related antidepressants and classical TCAs may have different side effect profiles and are associated with differing withdrawal rates when compared with SSRIs .