***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: OBJECTIVE To compare the efficacy and tolerability of paroxetine ( a selective serotonin reuptake inhibitor ) with that of amitriptyline ( a tricyclic antidepressant ) in the treatment of depression in 191 patients with rheumatoid arthritis ( RA ) . METHODS A r and omized , double blind , double dummy , parallel group study . A placebo washout period of 3 - 7 days was followed by an 8 week active treatment phase during which patients received either paroxetine ( 20 - 40 mg daily ) or amitriptyline ( 75 - 150 mg daily ) . The primary efficacy variable was the change from baseline in Montgomery Asberg Depression Rating Scale score at endpoint . RESULTS Paroxetine was as effective as amitriptyline for the treatment of depression , with similar improvements in RA associated pain and disability also seen in both groups . However , paroxetine was better tolerated than amitriptyline , with an overall frequency of adverse experiences of 56.4 % and 67.7 % in the 2 groups , respectively . The frequency of anticholinergic adverse experiences was much lower in the paroxetine treatment group ( 18.1 % vs 43.8 % taking amitriptyline ) and paroxetine treated patients also experienced fewer severe ( 16.0 % vs 21.9 % ) , serious nonfatal ( 0 % vs 4.2 % ) , and drug related adverse experiences ( 12.8 % vs 29.2 % ) . CONCLUSION Tolerability is an important consideration in this patient population , which is largely composed of elderly patients who are taking additional medications for RA .  Paroxetine shows a number of advantages in the management of depression comorbid with RA Thirty-six patients with definite or classical rheumatoid arthritis participated in a double-blind , r and omized , placebo-controlled trial to assess the effectiveness of adding amitriptyline to the treatment regimen for the relief of pain not adequately controlled by non-steroidal anti-inflammatory drugs . Dosage of amitriptyline was increased gradually up to 25 mg 3-times daily and patients were followed up for 12 weeks . Assessment s were made of joint pain and tenderness every 4 weeks . The results showed no difference between the amitriptyline and placebo-treated patients for either parameter 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 We report an open-label trial of sertraline in the treatment of major depression in 54 consecutive rheumatoid arthritis ( RA ) patients meeting DSM-IV criteria for major depressive disorder . We initially surveyed 628 RA out patients with the Center for Epidemiologic Studies Depression Scale ( CES-D )  and invited those with depression to be evaluated further and treated . Eighty-four RA patients reporting depressive symptoms agreed to participate in person , and 56 met the criteria for major depressive disorder . Of these 56 patients , 54 agreed to medication treatment and were enrolled in the study . Patients were also r and omized to one of three psychological treatment conditions , but for this study , conditions were collapsed because previous research on this sample indicated no significant between-group differences in depression after treatment . Patients were assessed with the CES-D and the Hamilton Rating Scale for Depression after the intervention , at 6-month follow-up , and at 15-month follow-up . At the last follow-up , 41 patients remained for assessment . In this study ,  sertraline  was found to be a safe and efficacious treatment of depression complicating RA Actions on performance of  dextropropoxyphene ( DXP ) alone and in combination with amitriptyline ( AMI ) , indomethacin ( IN ) , and placebo were compared in 15 patients with rheumatoid arthritis . The patients were on their prescribed maintenance regimen excluding analgesics . In four r and omized test sessions at two-week intervals , they received double blind and crossover single oral doses of DXP 130 mg , IN 50 mg , DXP 65 mg + AMI 25 mg or placebo , each after two days ' pretreatment with the same drug . Objective and subjective effects were measured at baseline and 2 and 4 hours after drug administration . DXP impaired critical flicker discrimination , symbol copying and body balance without modifying tracking , choice reactions or attention . It rendered the subjects elated , muzzy , mentally slow and calm . Actions of AMI + DXP were about the same . IN impaired body balance and critical flicker recognition . Plasma concentrations of DXP were moderate to high whilst those of IN and AMI were fairly low . We conclude that therapeutic doses of DXP and IN are relatively safe in regard to driving skills . Small doses of AMI may not enhance the mild psychomotor effects of DXP . Earlier single dose studies carried out with healthy volunteers might have overestimated the decremental effects of analgesics on psychomotor performance OBJECTIVE To examine the effectiveness of cognitive-behavioral and pharmacologic treatment of  depression in rheumatoid arthritis ( RA ) . METHODS Subjects ( n = 54 ) with confirmed diagnoses of both major depression and RA were r and omly assigned to 1 of 3 groups : 1 ) cognitive-behavioral/pharmacologic group ( CB-PHARM ) , 2 ) attention-control/pharmacologic group , or 3 ) pharmacologic control group .  Measures of depression , psychosocial status , health status , pain , and disease activity were collected at baseline , posttreatment ( 10 weeks ) , 6-month followup , and 15-month followup . Data were analyzed to compare the treatment effectiveness of the groups ; data also were aggregated to examine the effects of antidepressive medication over time . Lastly , a no-treatment control group was defined from a cohort of persons who declined participation . RESULTS Baseline comparisons on demographic and dependent measures revealed a need to assess covariates on age and education ; baseline scores on dependent measures also were entered as covariates . Analyses of covariance revealed no statistically significant group differences at postintervention , 6-month followup , or 15-month followup , except higher state and trait anxiety scores for the CB-PHARM group at the 15-month followup . In the longitudinal analyses of the effects of antidepressive medication , significant improvement in psychological status and health status were found at posttreatment , 6-month followup , and 15-month followup , but no significant improvements were shown for pain or disease activity . In addition , the comparison of the aggregated pharmacologic group with a no-treatment group revealed a statistically significant benefit for the 3 groups that received the antidepressive medication . CONCLUSION In persons with RA , cognitive-behavioral approaches to the management of depression were not found to be additive to antidepressant medication alone , but antidepressant intervention was superior to no treatment Summary A double-blind placebo-controlled trial was carried out in 20 patients with classical rheumatoid arthritis to study the effect of imipramine on rheumatoid factor titres . Patients were allocated at r and om to receive 6-weeks treatment with imipramine , in low dosage , or placebo in addition to their antirheumatic medication . They were then followed up for a further 4 weeks during which only their antirheumatic medication was continued . Assessment s were made , at entry and after 3,6 and 10 weeks , of rheumatoid factor titres , pain scores , articular index , PIP joint size , grip strength , erythrocyte sedimentation rate and depression index . The results showed that changes in rheumatoid factor titre in the placebo and post-treatment groups were similar to changes occurring during the administration of imipramine . There was , however , a significant correlation between the changes in depression rating score and articular index A r and omised , double‐blind , multiple dose , crossover study with three 3‐week treatment periods was set up to compare the analgesic efficacy and adverse effects of amitriptyline in oral doses of 25 , 50 or 75 mg . Patients used diaries to assess their pain , and clinic assessment s were made at the end of each treatment period . It was found that in 29 patients with chronic ( more than 2 months ) pain , amitriptyline 75 mg provided significantly greater efficacy than amitriptyline 25 or 50 mg . There was no significant difference in mood scores between the different doses of amitriptyline , but sleep was judged significantly better with 75 mg compared with 25 mg . The incidence of adverse effects was significantly higher with the 75 mg dose , and the principal adverse effects were dry mouth and drowsiness . In the context of chronic pain , the analgesic effect of amitriptyline was shown to have a dose‐response unrelated to mood elevation , but there was a dose‐response for the incidence of adverse effects The effect of low-dose trimipramine ( 25 to 75 mg/day ) on joint pain and tenderness in 36 patients with rheumatoid arthritis was studied in a r and omized double-blind trial carried out over a period of 12 weeks . The patients were pre-selected to include only patients who were depressed on a ' self-rating depression scale ' but had no evidence of fibrositic ' trigger-points ' . The results showed that joint pain and tenderness were significantly reduced with trimipramine , but depression scores remained unchanged & NA ; The aim of this study was to examine the impact of pain on quality of life and its components in a representative sample of 320 well people , and patients selected from all major categories of illness .  Quality of life was assessed using a new , multidimensional , multilingual , generic profile design ed for cross‐cultural use in health care , i.e. the WHOQOL . Within the WHOQOL , pain and discomfort is one of 29 areas or facets of quality of life , grouped into six domains . It was found that pain and discomfort made a significant impact on perceptions of general quality of life related to health . Furthermore , the presence of pain affected perceptions of five of the six domains of quality of life ; the domain of spirituality , religion and personal beliefs being the exception . When quality of life is assessed , negative feelings are most closely associated with reports of pain and discomfort than any other facet . But quality of life surrounding pain and discomfort is more fully explained by the inclusion of six additional facets ; the availability of social care , mobility , activities of daily living , positive mood and to a lesser extent , sleep and dependence on medication . Together , these seven facets represent criteria against which the success of pain treatments may be evaluated . As predicted , those who were pain‐free had significantly better quality of life than those in pain . A longer duration of pain is associated with increasingly poorer quality of life . Intense affective pain is particularly detrimental to a good quality of life . The psychometric properties of the pain and discomfort facet of the WHOQOL and WHOQOL‐100 were assessed . Internal consistency ( reliability ) , discriminant and criterion/concurrent validity were found to be good to excellent , justifying the use of this instrument with a range of chronic and acute pain patients A long-term ( two years ) double-blind , comparative trial of diftalone ( Aladione ® )  500 mg  versus indomethacin  75 mg per day , in rheumatoid arthritis ( thirty-two patients ) , has shown a similar effectiveness for both anti-inflammatory agents on various clinical parameters of disease activity , some better results being obtained for diftalone as regards the capacity of reducing erythrocyte sedimentation rate . The tolerability of diftalone proved to be somewhat superior , as is shown by the lower number of patients complaining of side-effects or being dropped out for intolerance , and by the lower frequency of central nervous system disturbances In a r and omized , double-blind , parallel study , fluoxetine and amitriptyline were compared with placebo in the treatment of chronic rheumatic pain . A total of 59 patients were evaluated during 4 wk of treatment and received 20 mg fluoxetine , 25 mg amitriptyline , or placebo daily . Pain intensity , pain relief , vital variables , and global evaluation were used to assess efficacy . To evaluate safety variables , the incidence of side effects was noted . Both amitriptyline and fluoxetine significantly reduced pain intensity compared with placebo . Similarly , pain relief was greater with both amitriptyline and fluoxetine than with placebo . At the end of the fourth week , fluoxetine was superior in efficacy to amitriptyline . The incidence of adverse effects was significantly greater with amitriptyline ; dryness of the mouth was the most predominant side effect . We conclude that fluoxetine is an effective analgesic with 
    Output:
    
The qualitative analyses found no evidence of an effect of antidepressants on pain intensity or depression in the short-term ( less than one week ) , and conflicting evidence of a medium- ( one to six weeks ) or long-term ( more than six weeks ) benefit .
The use of these agents may be associated with adverse events which are generally mild and do not lead to cessation of treatment .