human
***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: 1 . There is increasing evidence that many patients with major depression also have coexisting dysthymia , and that antidepressant treatment may alleviate both conditions . 2 . Open-label study of fluoxetine and trazodone for 18 patients meeting DSM-III-R criteria for concurrent dysthymia and major depression . 3 . Fourteen patients completed three-month medication trials , and seven ( 50 % ) of completers ) responded to treatment . At five months , eight ( 57.1 % ) were in remission .  Fluoxetine was significantly better tolerated than trazodone , with respective dropout rates of 7.7 % and 80 % . 4 . Findings are consistent with efficacy of serotonergic agents in this condition BACKGROUND Despite the high prevalence of dysthymia and its associated morbidity , few controlled trials have evaluated the efficacy of antidepressant medication for this disorder . A 12-week , double-blind , placebo-controlled , r and omized , multicenter trial was performed to evaluate the safety and efficacy of sertraline hydrochloride and imipramine hydrochloride in treating dysthymia . METHODS A total of 416 out patients ( 271 women and 145 men ) aged 25 to 65 years with DSM-III-R-defined , early-onset , primary dysthymia without concurrent major depression were r and omized to 12 weeks of treatment with  sertraline , imipramine , or placebo . RESULTS Both active treatments result ed in significantly reduced scores on the 17-item Hamilton Rating Scale for Depression ( P = .04 and P = .01 for sertraline and imipramine vs placebo , respectively ) , the Montgomery-Asberg Depression Rating Scale ( P = .01 and P = .003 vs placebo , respectively ) , Hopkins Symptom Checklist ( P < .05 ) , and the self-rated version of the Inventory of Depressive Symptoms ( P < .05 ) . With the use of a Clinical Global impressions improvement score of 1 or 2 ( very much or much improved ) to define response , response rates were 59 % for sertraline , 64 % for imipramine , and 44 % for placebo ( P = .02 for sertraline vs placebo and P < .001 for imipramine vs placebo ) . A significantly greater proportion of patients receiving imipramine than those receiving sertraline or placebo discontinued treatment because of adverse events ( P = .001 and P < .001 , respectively ) . CONCLUSIONS Pharmacotherapy provides considerable relief from the symptoms of dysthymia in patients suffering from this chronic affective disorder , with both sertraline and imipramine being more effective than placebo . The greater tolerability of sertraline is an important consideration because of the chronicity of dysthymia , which may require prolonged treatment with antidepressant medication BACKGROUND There have been very few controlled studies of antidepressants in dysthymia , particularly in sample s diagnosed reliably and with an adequate length of follow-up . In this investigation , we measured the long-term outcome in a large group of patients meeting DSM-III-R criteria for dysthymia . This study was design ed to investigate whether fluoxetine is effective in the treatment of dysthymia . METHOD This r and omised study including 140 patients , compared  fluoxetine ( 91 patients ) and placebo ( 49 patients ) on a double-blind basis in two distinct phases : a short-term end-point ( 3 months with 20 mg/day fluoxetine ) and a medium-term end-point ( 6 months ) where the initial responders continued double-blind treatment unchanged and non-responders received an additional treatment of 20 mg/day fluoxetine . RESULTS After three months of treatment , response was seen more frequently in the fluoxetine group ( 42/72 ) than in the placebo group ( 14/39 , P < 0.0001 ) . Improved patients at 3 months were still improved at 6 months . Furthermore , 50 % of the nonresponders at 3 months improved and rated as responders at 6 months , after fluoxetine was increased to 40 mg daily . CONCLUSIONS This study showed the significant and persistent action of fluoxetine on dysthymia . The finding that 50 % of the non-responders at 3 months were improved at 6 months , after fluoxetine dosage was increased to 40 mg daily , argues in favour of treating dysthymic patients for at least 6 months , and with a higher dosage if the initial doses are ineffective BACKGROUND Over the past decade , studies of the effectiveness of pharmacological treatment for depression have often been based on research design s intended to measure efficacy , and for this reason the results are of limited generalizability . Research is needed comparing the clinical and economic outcomes of antidepressants in day-to-day clinical practice . METHODS A six-month r and omised prospect i ve naturalistic study comparing fluoxetine to imipramine carried out in three primary care health centres . Outcome measures were the Montgomery Asberg Depression Rating Scale ( MADRS ) , direct costs , indirect costs and total costs . Subjects were evaluated at the beginning of treatment and at one , three and six months thereafter . RESULTS Of the 103 patients , 38.8 % ( n = 40 ) were diagnosed with major depressive disorder , 14.6 % ( n = 15 ) with dysthymic disorder , and 46.6 % ( n = 48 ) with depressive disorder not otherwise specified . Patients with major depressive disorder or dysthymic disorder achieved similar clinical improvement in both treatment groups ( mean MADRS ratings decrease in major depressive disorder from baseline to 6 months of 18.3 for imipramine and 18.8 for fluoxetine ) . For patients with major depressive disorder and dysthymic disorder , the imipramine group had fewer treatment-associated costs ( imipramine 469.66 Euro versus fluoxetine 1,585.93 Euro in major depressive disorder , p < 0.05 ; imipramine 175.39 Euro versus fluoxetine 2,929.36 Euro in dysthymic disorder , p < 0.05 ) . The group with depressive disorder not otherwise specified did not experience statistically significant differences in clinical and costs outcomes between treatment groups . LIMITATIONS Exclusion criteria , participating physicians may not represent GPs . CONCLUSIONS In a primary care context , imipramine may represent a more cost-effective treatment option than fluoxetine for treating major depressive disorder or dysthymic disorder . There were no differences in cost-effectiveness in the treatment of depressive disorder not otherwise specified CONTEXT Insufficient evidence exists for recommendation of specific effective treatments for older primary care patients with minor depression or dysthymia . OBJECTIVE To compare the effectiveness of pharmacotherapy and psychotherapy in primary care setting s among older persons with minor depression or dysthymia . DESIGN R and omized , placebo-controlled trial ( November 1995-August 1998 ) . SETTING Four geographically and clinical ly diverse primary care practice s. PARTICIPANTS A total of 415 primary care patients ( mean age , 71 years ) with minor depression ( n = 204 ) or dysthymia ( n = 211 ) and a Hamilton Depression Rating Scale ( HDRS ) score of at least 10 were r and omized ; 311 ( 74.9 % ) completed all study visits . INTERVENTIONS Patients were r and omly assigned to receive paroxetine ( n = 137 ) or placebo ( n = 140 ) , starting at 10 mg/d and titrated to a maximum of 40 mg/d , or problem-solving treatment- primary care ( PST-PC ; n = 138 ) . For the paroxetine and placebo groups , the 6 visits over 11 weeks included general support and symptom and adverse effects monitoring ; for the PST-PC group , visits were for psychotherapy . MAIN OUTCOME MEASURES Depressive symptoms , by the 20-item Hopkins Symptom Checklist Depression Scale ( HSCL-D-20 ) and the HDRS ; and functional status , by the Medical Outcomes Study Short-Form 36 ( SF-36 ) physical and mental components . RESULTS Paroxetine patients showed greater ( difference in mean [ SE ] 11-week change in HSCL-D-20 scores , 0.21 [ 0 . 07 ] ; P = .004 ) symptom resolution than placebo patients . Patients treated with PST-PC did not show more improvement than placebo ( difference in mean [ SE ] change in HSCL-D-20 scores , 0.11 [ 0.13 ] ; P = .13 ) , but their symptoms improved more rapidly than those of placebo patients during the latter treatment weeks ( P = .01 ) . For dysthymia , paroxetine improved mental health functioning vs placebo among patients whose baseline functioning was high ( difference in mean [ SE ] change in SF-36 mental component scores , 5.8 [ 2.02 ] ; P = . 01 ) or intermediate ( difference in mean [ SE ] change in SF-36 mental component scores , 4.4 [ 1.74 ] ; P = .03 ) . Mental health functioning in dysthymia patients was not significantly improved by PST-PC compared with placebo ( P>/=.12 for low- , intermediate- , and high-functioning groups ) . For minor depression , both paroxetine and PST-PC improved mental health functioning in patients in the lowest tertile of baseline functioning ( difference vs placebo in mean [ SE ] change in SF-36 mental component scores , 4.7 [ 2.03 ] for those taking paroxetine ; 4.7 [ 1.96 ] for the PST-PC treatment ; P = .02 vs placebo ) . CONCLUSIONS Paroxetine showed moderate benefit for depressive symptoms and mental health function in elderly patients with dysthymia and more severely impaired elderly patients with minor depression . The benefits of PST-PC were smaller , had slower onset , and were more subject to site differences than those of paroxetine OBJECTIVE Chronic depression starts at an early age for many individuals and could affect their accumulation of " human capital " ( i.e. , education , higher amounts of which can broaden occupational choice and increase earnings potential ) . The authors examined the impact , by gender , of early- ( before age 22 ) versus late-onset major depressive disorder on educational attainment . They also determined whether the efficacy and sustainability of antidepressant treatments and psychosocial outcomes vary by age at onset and quantified the impact of early- versus late-onset , as well as never-occurring , major depressive disorder on expected lifetime earnings . METHOD The authors used logistic and multivariate regression methods to analyze data from a three-phase , multicenter , double-blind , r and omized trial that compared sertraline and imipramine treatment of 531 patients with chronic depression aged 30 years and older . These data were integrated with U.S. Census Bureau data on 1995 earnings by age , educational attainment , and gender . RESULTS Early-onset major depressive disorder adversely affected the educational attainment of women but not of men . No significant difference in treatment responsiveness by age at onset was observed after 12 weeks of acute treatment or , for subjects rated as having responded , after 76 weeks of maintenance treatment . A r and omly selected 21-year-old woman with early-onset major depressive disorder in 1995 could expect future annual earnings that were 12%-18 % lower than those of a r and omly selected 21-year-old woman whose onset of major depressive disorder occurred after age 21 or not at all . CONCLUSIONS Early-onset major depressive disorder causes substantial human capital loss , particularly for women . Detection and effective treatment of early-onset major depressive disorder may have substantial economic benefits BACKGROUND Chronic depressions are common , disabling , and undertreated , and prior chronicity predicts future chronicity . However , few studies directly inform the acute or maintenance phase treatments of chronic depressions and even less is known about the effects of treatment on psychosocial functioning . METHOD We describe the design and rationale for 2 parallel double-blind , r and omized , multicenter acute and maintenance phase treatment trials . One focused on DSM-III-R major depression currently in a chronic ( > or = 2 years ) major depressive episode , the other on DSM-III-R major depression with concurrent DSM-III-R dysthymia ( " double depression " ) . RESULTS Considering the critical knowledge deficits , we design ed a 12-week acute phase safety and efficacy trial of sertraline versus imipramine , followed by a 16-week continuation treatment phase for subjects with a satisfactory therapeutic response . Patients receiving sertraline who successfully completed the continuation phase entered a 76-week maintenance trial to compare sertraline with placebo ; those taking imipramine continued without a placebo substitution . As part of the acute trial , subjects completing but failing to respond to the initial 12-week acute phase medication were crossed over ( double-blind ) to the alternative medication for a 12-week acute phase trial . We obtained naturalistic follow-up data ( up to 18 months ) for subjects exiting the protocol at any time . CONCLUSION Multiphase protocol s for chronic depression can test efficacy by r and omized contrasts as well as shed light on key clinical issues such as the 
    Output:
    
agent
CONCLUSIONS This systematic review provides evidence for the efficacy of both SSRIs and TCAs in the treatment of chronic depression and showed a better acceptability of SSRIs
***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: 1 . There is increasing evidence that many patients with major depression also have coexisting dysthymia , and that antidepressant treatment may alleviate both conditions . 2 . Open-label study of fluoxetine and trazodone for 18 patients meeting DSM-III-R criteria for concurrent dysthymia and major depression . 3 . Fourteen patients completed three-month medication trials , and seven ( 50 % ) of completers ) responded to treatment . At five months , eight ( 57.1 % ) were in remission .  Fluoxetine was significantly better tolerated than trazodone , with respective dropout rates of 7.7 % and 80 % . 4 . Findings are consistent with efficacy of serotonergic agents in this condition BACKGROUND Despite the high prevalence of dysthymia and its associated morbidity , few controlled trials have evaluated the efficacy of antidepressant medication for this disorder . A 12-week , double-blind , placebo-controlled , r and omized , multicenter trial was performed to evaluate the safety and efficacy of sertraline hydrochloride and imipramine hydrochloride in treating dysthymia . METHODS A total of 416 out patients ( 271 women and 145 men ) aged 25 to 65 years with DSM-III-R-defined , early-onset , primary dysthymia without concurrent major depression were r and omized to 12 weeks of treatment with  sertraline , imipramine , or placebo . RESULTS Both active treatments result ed in significantly reduced scores on the 17-item Hamilton Rating Scale for Depression ( P = .04 and P = .01 for sertraline and imipramine vs placebo , respectively ) , the Montgomery-Asberg Depression Rating Scale ( P = .01 and P = .003 vs placebo , respectively ) , Hopkins Symptom Checklist ( P < .05 ) , and the self-rated version of the Inventory of Depressive Symptoms ( P < .05 ) . With the use of a Clinical Global impressions improvement score of 1 or 2 ( very much or much improved ) to define response , response rates were 59 % for sertraline , 64 % for imipramine , and 44 % for placebo ( P = .02 for sertraline vs placebo and P < .001 for imipramine vs placebo ) . A significantly greater proportion of patients receiving imipramine than those receiving sertraline or placebo discontinued treatment because of adverse events ( P = .001 and P < .001 , respectively ) . CONCLUSIONS Pharmacotherapy provides considerable relief from the symptoms of dysthymia in patients suffering from this chronic affective disorder , with both sertraline and imipramine being more effective than placebo . The greater tolerability of sertraline is an important consideration because of the chronicity of dysthymia , which may require prolonged treatment with antidepressant medication BACKGROUND There have been very few controlled studies of antidepressants in dysthymia , particularly in sample s diagnosed reliably and with an adequate length of follow-up . In this investigation , we measured the long-term outcome in a large group of patients meeting DSM-III-R criteria for dysthymia . This study was design ed to investigate whether fluoxetine is effective in the treatment of dysthymia . METHOD This r and omised study including 140 patients , compared  fluoxetine ( 91 patients ) and placebo ( 49 patients ) on a double-blind basis in two distinct phases : a short-term end-point ( 3 months with 20 mg/day fluoxetine ) and a medium-term end-point ( 6 months ) where the initial responders continued double-blind treatment unchanged and non-responders received an additional treatment of 20 mg/day fluoxetine . RESULTS After three months of treatment , response was seen more frequently in the fluoxetine group ( 42/72 ) than in the placebo group ( 14/39 , P < 0.0001 ) . Improved patients at 3 months were still improved at 6 months . Furthermore , 50 % of the nonresponders at 3 months improved and rated as responders at 6 months , after fluoxetine was increased to 40 mg daily . CONCLUSIONS This study showed the significant and persistent action of fluoxetine on dysthymia . The finding that 50 % of the non-responders at 3 months were improved at 6 months , after fluoxetine dosage was increased to 40 mg daily , argues in favour of treating dysthymic patients for at least 6 months , and with a higher dosage if the initial doses are ineffective BACKGROUND Over the past decade , studies of the effectiveness of pharmacological treatment for depression have often been based on research design s intended to measure efficacy , and for this reason the results are of limited generalizability . Research is needed comparing the clinical and economic outcomes of antidepressants in day-to-day clinical practice . METHODS A six-month r and omised prospect i ve naturalistic study comparing fluoxetine to imipramine carried out in three primary care health centres . Outcome measures were the Montgomery Asberg Depression Rating Scale ( MADRS ) , direct costs , indirect costs and total costs . Subjects were evaluated at the beginning of treatment and at one , three and six months thereafter . RESULTS Of the 103 patients , 38.8 % ( n = 40 ) were diagnosed with major depressive disorder , 14.6 % ( n = 15 ) with dysthymic disorder , and 46.6 % ( n = 48 ) with depressive disorder not otherwise specified . Patients with major depressive disorder or dysthymic disorder achieved similar clinical improvement in both treatment groups ( mean MADRS ratings decrease in major depressive disorder from baseline to 6 months of 18.3 for imipramine and 18.8 for fluoxetine ) . For patients with major depressive disorder and dysthymic disorder , the imipramine group had fewer treatment-associated costs ( imipramine 469.66 Euro versus fluoxetine 1,585.93 Euro in major depressive disorder , p < 0.05 ; imipramine 175.39 Euro versus fluoxetine 2,929.36 Euro in dysthymic disorder , p < 0.05 ) . The group with depressive disorder not otherwise specified did not experience statistically significant differences in clinical and costs outcomes between treatment groups . LIMITATIONS Exclusion criteria , participating physicians may not represent GPs . CONCLUSIONS In a primary care context , imipramine may represent a more cost-effective treatment option than fluoxetine for treating major depressive disorder or dysthymic disorder . There were no differences in cost-effectiveness in the treatment of depressive disorder not otherwise specified CONTEXT Insufficient evidence exists for recommendation of specific effective treatments for older primary care patients with minor depression or dysthymia . OBJECTIVE To compare the effectiveness of pharmacotherapy and psychotherapy in primary care setting s among older persons with minor depression or dysthymia . DESIGN R and omized , placebo-controlled trial ( November 1995-August 1998 ) . SETTING Four geographically and clinical ly diverse primary care practice s. PARTICIPANTS A total of 415 primary care patients ( mean age , 71 years ) with minor depression ( n = 204 ) or dysthymia ( n = 211 ) and a Hamilton Depression Rating Scale ( HDRS ) score of at least 10 were r and omized ; 311 ( 74.9 % ) completed all study visits . INTERVENTIONS Patients were r and omly assigned to receive paroxetine ( n = 137 ) or placebo ( n = 140 ) , starting at 10 mg/d and titrated to a maximum of 40 mg/d , or problem-solving treatment- primary care ( PST-PC ; n = 138 ) . For the paroxetine and placebo groups , the 6 visits over 11 weeks included general support and symptom and adverse effects monitoring ; for the PST-PC group , visits were for psychotherapy . MAIN OUTCOME MEASURES Depressive symptoms , by the 20-item Hopkins Symptom Checklist Depression Scale ( HSCL-D-20 ) and the HDRS ; and functional status , by the Medical Outcomes Study Short-Form 36 ( SF-36 ) physical and mental components . RESULTS Paroxetine patients showed greater ( difference in mean [ SE ] 11-week change in HSCL-D-20 scores , 0.21 [ 0 . 07 ] ; P = .004 ) symptom resolution than placebo patients . Patients treated with PST-PC did not show more improvement than placebo ( difference in mean [ SE ] change in HSCL-D-20 scores , 0.11 [ 0.13 ] ; P = .13 ) , but their symptoms improved more rapidly than those of placebo patients during the latter treatment weeks ( P = .01 ) . For dysthymia , paroxetine improved mental health functioning vs placebo among patients whose baseline functioning was high ( difference in mean [ SE ] change in SF-36 mental component scores , 5.8 [ 2.02 ] ; P = . 01 ) or intermediate ( difference in mean [ SE ] change in SF-36 mental component scores , 4.4 [ 1.74 ] ; P = .03 ) . Mental health functioning in dysthymia patients was not significantly improved by PST-PC compared with placebo ( P>/=.12 for low- , intermediate- , and high-functioning groups ) . For minor depression , both paroxetine and PST-PC improved mental health functioning in patients in the lowest tertile of baseline functioning ( difference vs placebo in mean [ SE ] change in SF-36 mental component scores , 4.7 [ 2.03 ] for those taking paroxetine ; 4.7 [ 1.96 ] for the PST-PC treatment ; P = .02 vs placebo ) . CONCLUSIONS Paroxetine showed moderate benefit for depressive symptoms and mental health function in elderly patients with dysthymia and more severely impaired elderly patients with minor depression . The benefits of PST-PC were smaller , had slower onset , and were more subject to site differences than those of paroxetine OBJECTIVE Chronic depression starts at an early age for many individuals and could affect their accumulation of " human capital " ( i.e. , education , higher amounts of which can broaden occupational choice and increase earnings potential ) . The authors examined the impact , by gender , of early- ( before age 22 ) versus late-onset major depressive disorder on educational attainment . They also determined whether the efficacy and sustainability of antidepressant treatments and psychosocial outcomes vary by age at onset and quantified the impact of early- versus late-onset , as well as never-occurring , major depressive disorder on expected lifetime earnings . METHOD The authors used logistic and multivariate regression methods to analyze data from a three-phase , multicenter , double-blind , r and omized trial that compared sertraline and imipramine treatment of 531 patients with chronic depression aged 30 years and older . These data were integrated with U.S. Census Bureau data on 1995 earnings by age , educational attainment , and gender . RESULTS Early-onset major depressive disorder adversely affected the educational attainment of women but not of men . No significant difference in treatment responsiveness by age at onset was observed after 12 weeks of acute treatment or , for subjects rated as having responded , after 76 weeks of maintenance treatment . A r and omly selected 21-year-old woman with early-onset major depressive disorder in 1995 could expect future annual earnings that were 12%-18 % lower than those of a r and omly selected 21-year-old woman whose onset of major depressive disorder occurred after age 21 or not at all . CONCLUSIONS Early-onset major depressive disorder causes substantial human capital loss , particularly for women . Detection and effective treatment of early-onset major depressive disorder may have substantial economic benefits BACKGROUND Chronic depressions are common , disabling , and undertreated , and prior chronicity predicts future chronicity . However , few studies directly inform the acute or maintenance phase treatments of chronic depressions and even less is known about the effects of treatment on psychosocial functioning . METHOD We describe the design and rationale for 2 parallel double-blind , r and omized , multicenter acute and maintenance phase treatment trials . One focused on DSM-III-R major depression currently in a chronic ( > or = 2 years ) major depressive episode , the other on DSM-III-R major depression with concurrent DSM-III-R dysthymia ( " double depression " ) . RESULTS Considering the critical knowledge deficits , we design ed a 12-week acute phase safety and efficacy trial of sertraline versus imipramine , followed by a 16-week continuation treatment phase for subjects with a satisfactory therapeutic response . Patients receiving sertraline who successfully completed the continuation phase entered a 76-week maintenance trial to compare sertraline with placebo ; those taking imipramine continued without a placebo substitution . As part of the acute trial , subjects completing but failing to respond to the initial 12-week acute phase medication were crossed over ( double-blind ) to the alternative medication for a 12-week acute phase trial . We obtained naturalistic follow-up data ( up to 18 months ) for subjects exiting the protocol at any time . CONCLUSION Multiphase protocol s for chronic depression can test efficacy by r and omized contrasts as well as shed light on key clinical issues such as the 
    Output:
    