***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 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 define the effect of low dose amitriptyline on fatigue , pain , and stiffness in patients with ankylosing spondylitis ( AS ) . METHODS One hundred consecutive patients with AS were r and omized to receive low dose amitriptyline up to 30 mg nightly or placebo for 2 weeks . Patients were assessed by the Bath Ankylosing Spondylitis Disease Activity ( BASDAI ) and Functional ( BASFI ) Indices pre and post-treatment . RESULTS Eighty-eight patients ( 44 amitriptyline , 44 placebo ) completed the study . Eight ( 5 amitriptyline , 3 placebo ) stopped treatment because of side effects ( e.g. , drowsiness , dryness of mouth ) and 4 provided insufficient data . Compared to placebo , the patients taking amitriptyline showed significantly greater improvement in restful sleep ( 66 vs 20 % ; p < 0.001 ) and their disease activity scores [ BASDAI amitriptyline 1.18 ( 23 % ) vs placebo 0.52 ( 10 % ) ; p = 0.024 ] . All other variables showed a trend to greater improvement by amitriptyline , although the differences were not statistically significant . CONCLUSION ( 1 ) In a 2 week study , low dose amitriptyline significantly improved sleep in AS and was well tolerated ; ( 2 ) as defined by BASDAI , there was a significant reduction in disease activity with amitriptyline ; ( 3 ) compared to placebo , there was a nonsignificant trend toward improvement in function ; and ( 4 ) in spite of improvement in pain , fatigue , and sleep with amitriptyline , stiffness was not increased 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 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 Forty-seven patients with definite rheumatoid arthritis ( RA ) were treated in a 32 week , double blind , crossover trial of amitriptyline , desipramine , trazodone , and placebo . All drug regimens produced significant changes on pain measures relative to baseline , but only amitriptyline exceeded placebo . Amitriptyline was associated with a significant reduction in the number of painful/tender joints . Our study supports the efficacy of a moderate dose of amitriptyline as an adjunct drug for the treatment of pain in both depressed and nondepressed patients with RA BACKGROUND The relative importance of direct analgesic and antidepressant effects of antidepressant drugs in rheumatoid arthritis ( RA ) is not clear . METHOD Forty-eight female out- patients with RA , with depression and /or anxiety , were entered into a double-blind , placebo-controlled study of dothiepin in doses up to 150 mg daily to assess the effects on mood [ Hospital Anxiety and Depression ( HAD ) scale and Hamilton Rating Scale ( HRS ) for Depression ] , pain [ visual analogue scale ( VAS ) ] and disability [ Health Assessment Question naire ( HAQ ) ] . RESULTS Repeated measures multivariate analysis of variance revealed that treatment had a significant effect on pain ( F(d.f . 1,39 ) = 5.7 , P=0.02 ) . There were further interaction effects between treatment and time on pain ( F(d . f. 3,117 ) = 3.3 , P=0.03 ) , disability ( F(d.f . 3,117)=4.2 , P=0.008 ) and duration of early morning stiffness ( F(d.f . 3,117 ) = 3.3 , P=0.03 ) . Depression ( HRS ) was considerably reduced in both the dothiepin and placebo groups , and there was no significant difference between groups . Post hoc analyses using analysis of covariance revealed that , in the dothiepin group , pain was significantly reduced by week 4 and remained so at week 12 . Disability scores and duration of early morning stiffness were consistently lower in the dothiepin group , although differences failed to reach statistical significance at any follow-up assessment . In the group as a whole , reductions in pain were highly significantly correlated with reductions in HAD depression ( r = 0.63 , P<0.0005 ) , HAD anxiety ( r=0.46 , P=0.001 ) and HRS depression ( r=0.37 , P=0.01 ) . CONCLUSION Dothiepin is effective in relieving pain , disability and reducing the duration of early morning stiffness  in out- patients with RA . Although there is a general association between pain reduction and improved anxiety and depression , the analgesic effect of dothiepin is independent of its antidepressant effect . Individual variation is considerable and further research should try to identify mechanisms of interaction between the antidepressant and analgesic effects of treatment in different patient groups 
    Output:
    
The use of these agents may be associated with adverse events that are generally mild and do not lead to cessation of treatment .