***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: This paper reports the results of two studies of depressed patients , evaluating the efficacy and toleration of the selective serotonin reuptake inhibitor  ( SSRI ) sertraline  in a general practice setting in the UK . In the first of these studies , 308 patients , with a DSM-III-R diagnosis of major depressive episode , were treated for 6 weeks with either sertraline 50–100 mg/day or the tricyclic antidepressant dothiepin 75–150 mg/day , or placebo . Seventy-six per cent of sertraline-treated patients were maintained on the lower dose ( 50 mg/day ) , whereas 81 % of dothiepin-treated patients required the higher dose ( 150 mg/day ) . Sertraline-treated patients demonstrated a significant improvement in the Montgomery-Asberg Depression Rating Scale ( MADRS ) and the Clinical Global Impression ( CGI ) severity scores compared with placebo-treated patients , while dothiepin-treated patients did not show significant improvement compared with placebo . The active drugs were well tolerated , and there were no significant differences in adverse events between the groups . The second study , “ Sertraline in General Practice , A Multicenter Assessment ” , or SIGMA , was a large , multicentre trial with a cohort of 3396 patients recruited to receive 6 weeks of treatment . Patients started on sertraline 50 mg/day , and for 59 % of patients this was the final dose ; less than 10 % of patients reached final doses of more than 100 mg/day . A 50 % or greater reduction in MADRS scores was seen in 69 % of patients across a wide range of severity of symptoms at baseline , and 87 % of patients demonstrated excellent or good toleration of the drug . A review of the relevant literature and the results of these studies show that sertraline is well suited to treatment of depression in the general practice setting 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 In summary , the clinical results of this double-blind study clearly show that imipramine , as expected , demonstrated significant antidepressive properties in out patients suffering from major depressive disorders . In contrast , adinazolam showed rather mild and weak antidepressive properties , and in no measures did its response differ significantly from that of diazepam . These findings are quite in contrast to those obtained by the authors in an earlier study with alprazolam ( Rickels et al. , 1987 ) in which alprazolam and imipramine produced rather similar results and both were significantly better than placebo , while diazepam was not . While the rather high dropout rate may well be considered a limitation of the study , the dropout rate is equally distributed between all four treatments . And since both decreasing sample size and endpoint analyses which include all patients with at least one week data , provide rather similar results , the findings can be considered as robust despite the high dropout rate . While the authors consider those findings the most robust in which endpoint and completer analyses results are rather similar , when high dropout rates occur , endpoint analyses should be given more weight than completer analyses as they are more representative of actual clinical practice . The present findings therefore suggest that adinazolam clearly possesses less antidepressive properties than imipramine and not more than diazepam and these findings are in agreement with other studies which found lack of significant antidepressant activity for such benzodiazepines as diazepam ( Covi et al. , 1974 ) and chlordiazepoxide ( Lipman et al. , 1986 ) . The presence of only borderline antidepressive effects combined with rebound symptoms occurring already after only 6 weeks of therapy does not recommend adinazolam for use in depression . ( ABSTRACT TRUNCATED AT 250 WORDS 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 AIMS This paper describes the methods used in a study of the prevalence and types of common mental disorders among patients attending New Zeal and general practice s , and reports some key findings from the first phase of the study . The study also aim ed to determine the degree of associated disability and other factors influencing recognition , management , course and outcome of these disorders , and subsequent papers will address these issues . METHODS General practitioners ( GPs ) were selected r and omly . In the first phase of the study , all adult attenders at each practice on selected days were administered a short question naire , the General Health Question naire ( GHQ-12 ) , which screens for psychological symptoms . The GP recorded the reasons for each consultation , and was interviewed at the end of each day about selected patients to determine their opinion about the type of psychological problems experienced . Selected patients were then visited in their own homes and an extensive interview conducted , which included the Composite International Diagnostic Interview ( CIDI ) to determine mental health status , the World Health Organization 's Disability Assessment Schedule ( WHODAS ) to determine disability , and a detailed exploration of use of health services . In the second phase of the study , patients were contacted by telephone at three , six , nine and 12 months , and both patients and GPs were re-interviewed at 12 months . RESULTS The study achieved a very high response rate among the GPs ( 90 % ) . Nearly all eligible patients ( 93 % ) completed the  GHQ screening  , and their response rate was 70 % for the first-phase interview . GPs thought that 54 % of female and 46 % of male patients had experienced some level of psychological problems in the past year .  GHQ  screening also found that more than half of those attending their general practitioner experienced some psychological symptoms at initial screening , and the CIDI interview found that more than one in three had a diagnosable mental disorder during the past 12 months . The most common mental disorders were depressive , anxiety and substance use disorders . These disorders were more common among younger than older general practice attenders , and comorbidity was high . CONCLUSIONS Mental health problems are very common among general practice attenders . Contrary to the prevailing view that general practitioners seldom identify psychological problems in their patients , they identified about half their patients as having some type of psychological problems in the past year , although they considered that these were moderate or severe in about only one in ten patients . Further work from this large New Zeal and study will focus on the nature of the relationship between disorder and disability , and on the recognition , management and outcome of psychological problems 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 In a multicenter , placebo-controlled , clinical trial , the efficacy of Limbitrol was compared with that of its components , amitriptyline and chlordiazepoxide .  All patients had a diagnosis of primary depression . Data from 279 patients were evaluated using the Hamilton depression scale , the Beck depression inventory , and physician and patient global change measures .Statistically significant differences favoring Limbitrol occurred after 1 week of treatment , and a trend in favor of Limbitrol continued throughout the remaining 3 weeks . In most efficacy comparisons , the combination was as good as , or better than , amitriptyline alone . It was superior to chlordiazepoxide alone after 2 and 4 weeks of treatment . Each component produced an independent contribution to the total therapeutic effect : the chlordiazepoxide effect was more prominent in the first 2 weeks and the amitriptyline effect in the latter 2 weeks . A trend favoring amitriptyline over chlordiazepoxide was evident by week 4.The overall incidence of side effects was comparable in both Limbitrol- and amitriptyline-treated groups . Limbitrol-treated patients exhibited more sedation , but significantly fewer Limbitrol patients discontinued treatment prematurely because of side effects Of 580 patients r and omly assigned to short-term , double- 
    Output:
    
AUTHORS ' CONCLUSIONS Both TCAs and SSRIs are effective for depression treated in primary care