***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: We studied 11 patients with stable multiple sclerosis ( MS ) with major depression in terms of response to Sertraline  at 100 mg q.d . in an open label trial . Patients were evaluated with self assessment measurements ( Carroll scale ) prior to and during treatment . Only one patient discontinued the drug during the three month treatment trial , and this was due to perceived lack of efficacy by the patient . The remainder of the patients completed at least three months of treatment and had significant improvement in depressive symptoms by self assessment measurements . No patients experienced side effects .  Sertraline appears to be well tolerated and effective in treatment of major depression in MS . The Carroll scale is an easily administered means of assessing treatment response , and correlated highly with our clinical impressions In the double-blind study of 51 patients with duodenal ulcer the effect of doxepin and placebo was evaluated . Complete healing of the ulcer was found in 19 of 23 patients after 4 weeks of treatment with 50 mg doxepin ( 83 % ) and in 14 of 27 patients given placebo ( 52 % ) ( p less than 0.05 ) . Two patients in the placebo group developed complications necessitating surgical intervention . No serious side effects were registered in the doxepin group The reduction of pain by two antidepressants , clomipramine and mianserin , was , in this study on 253 patients with chronic idiopathic pain syndrome , found to be not better than a placebo when all patients were compared independently of the classification of pain . The improvement rate was around 40 % after 6 weeks of treatment when using a 50 % or better reduction in pain level . However , in patients who fulfilled a checklist definition of minor to major depression ( 30 % of the total patient material ) clomipramine was superior to mianserin and placebo with an improvement rate of 75 % after 6 weeks . Using pain curves over time as outcome measure in the various clinical pain categories it was found that both mianserin and clomipramine seemed superior to placebo in patients with tension headache , but in patients with low back pain syndrome placebo was superior to the two antidepressants . No difference among the three treatments was found in patients with burning mouth syndrome or in patients with abdominal pain . These differences underline the importance of study ing specific pain syndromes rather than composite groups of patients with idiopathic pain . The clinical significance of these pain curves needs further placebo controlled investigations Fluvoxamine belongs to the class of selective serotonin reuptake inhibitors ( SSRIs ) which have recently gained large popularity as antidepressant agents essentially because they lack the most troublesome adverse effects of older antidepressants ( i.e. tricyclic antidepressants ) such as anticholinergic effects and cardiotoxicity . Recent studies in the literature suggest that HIV-1 infected subjects are affected by depressive episodes with a relatively high frequency , often requiring an antidepressant treatment . Due to its favorable adverse effects profile , we used fluvoxamine as first line treatment for sixteen depressed HIV-1 infected subjects . They were administered the drug at a daily dosage of 100 mg in the evening . Fluvoxamine provided a good clinical efficacy for six of these patients , whereas the other ten had to discontinue the drug because of the presence of severe adverse effects such as acute total insomnia , gastro-intestinal disturbances together with anorexia , aggressive and impulsive behavior and excessive sedation . The observed fluvoxamine side-effects are not typical or specific for this particular patient group since they are also described in seronegative subjects taking fluvoxamine ; however , our findings seem to indicate that they become more frequent and more severe when the drug is administered to HIV-1 infected patients BACKGROUND No somatic treatment has been found to be effective for chronic fatigue syndrome ( CFS ) . Antidepressant therapy is commonly used . Fluoxetine is recommended in preference to tricyclic agents because it has fewer sedative and autonomic nervous system effects . However , there have been no r and omised , placebo-controlled , double-blind studies showing the effectiveness of antidepressant therapy in CFS . We have carried out such a study to assess the effect of fluoxetine in depressed and non-depressed CFS patients . METHODS In this r and omised , double-blind study , we recruited 44 patients to the depressed CFS group , and 52 to the non-depressed CFS group . In each group participants were r and omly assigned to receive either fluoxetine ( 20 mg once daily ) or placebo for 8 weeks . The effect of fluoxetine was assessed by question naires , self-observation lists , st and ard neuropsychological tests , and a motion-sensing device ( Actometer ) , which were applied on the day treatment started and on the last day . FINDINGS The two groups were well matched in terms of age , sex distribution , employment and marital status , and duration of CFS . There were no significant differences between the placebo and fluoxetine-treated groups in the change during the 8-week treatment period for any dimension of CFS . There was no change in subjective assessment s of fatigue , severity of depression , functional impairment , sleep disturbances , neuropsychological function , cognitions , or physical activity in the depressed or the non-depressed subgroup . INTERPRETATION Fluoxetine in a 20 mg daily dose does not have a beneficial effect on any characteristic of CFS . The lack of effect of fluoxetine on depressive symptoms in CFS suggests that processes underlying the presentation of depressive symptoms in CFS may differ from those in patients with major depressive disorder OBJECTIVE The authors present preliminary data from two treatment modalities of a r and omized clinical trial in which they compared 16-week interventions of interpersonal psychotherapy to supportive psychotherapy . METHOD HIV-positive patients who were not acutely medically ill and had scores of 15 or higher on the Hamilton Depression Rating Scale  were r and omly assigned to one of four treatment modalities . They were assessed by the Hamilton scale and Beck Depression Inventory at 8 and 16 weeks . Most subjects who underwent either interpersonal psychotherapy ( N = 16 ) or supportive psychotherapy ( N = 16 ) were male , gay or bisexual , white , and college educated . RESULTS Results of last-observation-carried-forward and completer analyses showed that scores on the Hamilton scale and Beck Depression Inventory decreased significantly for both treatments . Differential improvement for interpersonal psychotherapy appeared by midtreatment ( week 8) and persisted at termination . CONCLUSIONS This is the first controlled study of individual psychotherapies for depressed HIV-positive patients . Results suggest that a specific antidepressant psychotherapy , interpersonal psychotherapy , has advantages over a supportive therapy The effectiveness of dothiepin ( a tricyclic anti-depressant ) at a dose of 75 mg given orally at night was compared with placebo for 4 weeks in alleviating pain in 60 patients with classical or definite active rheumatoid arthritis . Patients were classified as either ‘ depressed ’ or ‘ not depressed ’ . The week before , during and 2 weeks after the study , 600 mg ibuprofen was given orally three times daily to all patients . Compared with placebo , dothiepin produced a significant reduction in daytime pain by the end of the treatment period . The Hamilton rating scale in ‘ depressed ’ patients was significantly improved in patients given dothiepin . The Cassano – Castrogiovanni self-evaluation rating scale in both ‘ depressed ’ and ‘ not depressed ’ patients showed a tendency ( not significant ) to be improved following dothiepin treatment compared with placebo . These results suggest that patients with rheumatoid arthritis may experience an increase in pain symptoms due to an alteration of mood . Therapy with tricyclic anti-depressants , such as dothiepin , therefore , may determine an improvement of pain indexes besides having an anti-depressant effect In coronary artery disease the patients usually manifest both anxiety and depression disturbances . A controlled clinical study was conducted to test the efficacy of a new antidepressant agent , maprotiline , in the early stages of acute myocardial infa rct ion . The sample consisted of 126 patients , sixty-three receiving orally 25 mg of maprotiline twice daily and the remainder 5 mg of diazepam twice daily  . Treatment lasted on an average two weeks ( ten days to eight weeks ) . The depressive and /or anxiety conditions were rated on the basis of a question naire administered before and after treatment . Depression improved markedly in patients receiving maprotiline , while the two drugs developed a comparable anxiolytic action . Tolerability was good . No clinical or ECG evidence of cardiotoxic signs was detected . The importance of a drug with these characteristics in the management of emotional disturbances in the early stages of coronary artery disease is emphasized OBJECTIVE The authors ' first objective was to ascertain whether imipramine is superior to placebo in treating axis I depressive disorders in the context of HIV illness . Supplementary questions were whether severity of immunodeficiency is associated with antidepressant response and whether patients with greater immunodeficiency can tolerate st and ard doses of imipramine . Second , the authors sought to determine whether imipramine treatment is associated with changes in immune status . METHOD A double-blind , r and omized  placebo-controlled trial of imipramine was conducted in a university-affiliated research outpatient clinic . After 6 weeks of treatment , responders were maintained double-blind for another 6 weeks and nonresponders were removed from the study and treated openly . All patients were offered 26 weeks of treatment . Of the 97 patients who were r and omly assigned to placebo or imipramine  , 80 completed the 6-week phase . Main outcome measures included the Clinical Global Impression , the Hamilton Depression Rating Scale , the Brief Symptom Inventory , and CD4 cell count . RESULTS Among study completers , 31 ( 39 % ) had AIDS  . The response rate to imipramine was 74 % and the response rate to placebo was 26 % . There was no difference in depression response between patients with more or less severe immunodeficiency , nor was there a difference in medication dose or side effects . Neither type nor duration of treatment influenced CD4 cell count during the course of treatment . CONCLUSIONS Depressed patients with HIV illness respond to imipramine at the same rate as medically healthy depressed patients .  Severity of immunosuppression is not associated with imipramine treatment outcome . There is no evidence that imipramine has negative effects on enumerative measures of immune status ECGs of 50 patients who completed a long-term nortriptyline ( NT ) study are presented at baseline , after 7 weeks on NT , and after 1 year . The ECGs of patients with preexisting cardiac disease were compared with non-cardiac patients . Significant ECG changes and increases in heart rate were observed by Week 7 and persisted at a mean of 55 weeks ( range : 24 - 111 ) in patients who were continued on NT . No significant difference was found in long-term ECG effects in patients with preexisting cardiac disease ; ECG changes reverted to baseline when placebo was substituted . Patients with known cardiac disease did not show significantly worse ECG changes on NT than non-cardiac patients Somatic symptoms often complicate the diagnosis and psychopharmacological treatment of depression in HIV illness . We treated 33 depressed HIV-positive men and women with medically symptomatic HIV or AIDS ( CDC stages 2B , 2C , 3B , or 3C ) in a 6 week open-label trial with sertraline , paroxetine , or fluoxetine , to assess their effectiveness and tolerability . We further assessed whether treatment of depression result ed in a reduction in both affective and somatic symptoms in this medically ill population . Twenty-four subjects ( 73 % ) completed the trial ( 7 on sertraline , 7 on paroxetine , 10 on fluoxetine ) , 20 ( 83 % ) of whom were clinical responders . Nine dropped out within 1 - 3 weeks of treatment because of adverse effects , mostly agitation , anxiety , and insomnia . Subjects who completed 6 weeks of SSRI treatment experienced significant reductions in both affective and somatic symptoms , many of the latter having been attributed to HIV rather than depression . These results suggest that , even in later stages of HIV illness , the contribution of depression to perceived somatic symptoms may be significant , and that these symptoms may improve with antidepressant treatment Sixty patients with chronic pain of the low back or cervical spine concomitant with clinical depression were studied in a 6-week , r and omized , double-blind comparison of doxepin and placebo . Significant improvements in the doxepin-treated group compared to placebo or to baseline values were seen on Hamilton depression scores , Global Assessment Scale scores , pain severity , percent of time pain felt , and effect of pain on activity , sleep , and muscle tension . Some improvements were observed after 1 week of treatment ; the most improvement occurred at 6 weeks , when the mean doxepin dosage was approximately 200 mg/day and plasma doxepin and nordoxepin averaged 80 ng/ml . No significant harmful effects were observed . Neither plasma beta-endorphin nor enkephalin-like activity demonstrated significant differences from baseline . These data indicate that doxepin is a valuable treatment for patients with chronic pain and depression Twenty-seven in patients participating in a stroke rehabilitation program were r and omized to receive either placebo or trazodone hydrochloride ( Desyrel ) beginning a mean ( + /- SEM ) of 44 + /- 4 days after stroke . The target dosage was 200 mg/d . Patients with either a clinical diagnosis of depression or abnormal Zung depression scores  showed a consistent trend toward greater improvement in Barthel activities of daily living ( ADL 
    Output:
    
Nortriptyline produced worse control in diabetes .
REVIEW ER 'S CONCLUSIONS The review provides evidence that antidepressants , significantly more frequently than either placebo or no treament , cause improvement in  depression  in patients with a wide range of physical diseases .