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: Background Alcohol dependence comorbid with major depressive disorder poses a major challenge in the clinical setting . The results in the treatment with selective serotonin re-uptake inhibitors have been conflicting . Thus , we compared in alcohol-dependent patients with co-morbid major depressive disorder the selective serotonin re-uptake inhibitor escitalopram to a compound that acts on different transporter system and may reduce craving , the glutamate receptor antagonist memantine . Methods Eighty alcohol-dependent patients comorbid with major depressive disorder in municipal alcohol clinics were r and omized 1:1 to receive memantine 20 mg or escitalopram 20 mg in a double-blind manner . During the 26-week study period patients continued their routine treatment at the clinics . Abstinence was not required but encouraged . The patients attended visits weekly during the first month , and then at 3 and at 6 months . Outcome measures were Alcohol Use Disorders Identification Test ( AUDIT ) , Obsessive Compulsive Drinking Scale ( OCDS ) and Drinking Diary . Results The completion rate was high in both groups , especially among the patients who had been abstinent at the beginning of the study . However , among those patients who were not abstinent at baseline , 47 % in both groups discontinued the study . Numbers of abstinent days were high in both groups throughout the study . Alcohol consumption measured by the AUDIT QF ( quantity-frequency ) score was significantly reduced in both groups , as was the craving for alcohol measured by the OCDS . Early age at first alcohol intoxication predicted poor treatment outcomes in patients treated with escitalopram , and the same was seen with the early onset of the first depressive episode . The same predictive effects were not found in patients treated with memantine . Conclusion Our results indicate that both memantine and escitalopram are useful adjunct medications for the treatment of alcohol dependence co-morbid with major depression . Memantine was at least as effective with regard to drinking as escitalopram . We believe that a direct comparison of memantine , with the commonly used escitalopram , can provide useful information for clinicians on the treatment of alcohol dependency co-morbid with MDD.Trial registration Clinical Trials.gov Identifier # Abstract The selective serotonin reuptake inhibitor citalopram was compared with clomipramine in a multicenter clinical study . From a total of 150 depressed patients ( age 18–65 years ) , 114 patients with a Hamilton Depression Scale ( HDS ) total score≧18 at the end of a 1 week placebo period were started on treatment with either citalopram ( 40 mg/day ) or clomipramine ( 150 mg/day ) ( fixed , single daily dose ) . Patients stratified according to diagnostic rating ( Newcastle Inventory , endogenous/non-endogenous ) were r and omly allocated to treatment groups using double blind principles . In total , 102 patients completed more than 2 weeks , treatment and were included in the analyses of therapeutic effect . The two drug groups were comparable in terms of sex , age , and departmental distribution . Categorical measurements of therapeutic effect based on the HDS total score showed that in the endogenously depressed patients a significantly higher percentage of patients on clomipramine ( n=37 ) than on citalopram ( n=38 ) were classified as complete responders ( HDS total≦7 ) after 3 , 4 and 5 weeks of treatment . In the non-endogenously depressed patients ( clomipramine : n=15 , citalopram : n=12 ) rather similar numerical differences were observed ( P<0.05 at 5th week ) . In the total patient group the percentage of complete response after 5 weeks was about 60 in the clomipramine group ( n=52 ) and about 30 in the citalopram group ( n=50 ) ( P<0.005 ) . The better effect of clomipramine seemed to be related in particular to the sleep items , but other items covering depression , retardation and anxiety/agitation also contributed to the difference in total score that was also seen in patients with low initial scores on the sleep items . Citalopram was devoid of the typical autonomic side effects and orthostatic hypotension seen with clomipramine . Symptoms of nausea/vomiting and headache became somewhat worse in the citalopram- and somewhat better in the clomipramine-treated patients . Participating centers:1Department of Psychiatry , Odense University Hospital , Odense , 2Department of Psychiatry , Rigshospitalet , University of Copenhagen , Copenhagen , 3Departments of Psychiatry , Frederiksborg General Hospital , Hillerød , 4Department A and C , Psychiatric University Hospital , Århus , 5Department of Psychiatry , Bornholm General Hospital , Rønne , 6Department of Clinical Pharmacology , Odense University , Odense Participating clinicians : J. And ersen2 , P. Bech2,3 , S. Benjaminsen1 , M. Bjerre1 , S. Bøjholm5 , P. Christensen1 , A. Gjerris2 , L. Hansted4 , E. Jensen3 , P. Kragh-Sørensen1 , C.B. Kristensen1,3 , P. Kyneb4 , D. Loldrup3 , O.F. Madsen4 , O.L. Pedersen1 , O.J. Rafaelsen2 , S. Rasmussen3 , N. Reisby4 , F. Sevaj3 , P. Simonsen4 , H.Y. Thomsen1 , P. Vestergaard4Coordination and drug assay : L.F. Gram6Statistical consultants : O. Aaskoven , P. Allerup Data - collection and -processing : C. Sánchez Steering Committee : P. Bech , L.F. Gram ( chairman ) , P. Kragh-Sørensen , O.J. Rafaelsen , N. Reisby , P. CONTEXT Previous studies indicate that industry-sponsored trials tend to draw proindustry conclusions . OBJECTIVE To explore whether the association between funding and conclusions in r and omized drug trials reflects treatment effects or adverse events . DESIGN Observational study of 370 r and omized drug trials included in meta-analyses from Cochrane review s selected from the Cochrane Library , May 2001 . From a r and om sample of 167 Cochrane review s , 25 contained eligible meta-analyses ( assessed a binary outcome ; pooled at least 5 full-paper trials of which at least 1 reported adequate and 1 reported inadequate allocation concealment ) . The primary binary outcome from each meta- analysis was considered the primary outcome for all trials included in each meta- analysis . The association between funding and conclusions was analyzed by logistic regression with adjustment for treatment effect , adverse events , and additional confounding factors ( method ological quality , control intervention , sample size , publication year , and place of publication ) . MAIN OUTCOME MEASURE Conclusions in trials , classified into whether the experimental drug was recommended as the treatment of choice or not . RESULTS The experimental drug was recommended as treatment of choice in 16 % of trials funded by nonprofit organizations , 30 % of trials not reporting funding , 35 % of trials funded by both nonprofit and for-profit organizations , and 51 % of trials funded by for-profit organizations ( P<.001 ; chi2 test ) . Logistic regression analyses indicated that funding , treatment effect , and double blinding were the only significant predictors of conclusions . Adjusted analyses showed that trials funded by for-profit organizations were significantly more likely to recommend the experimental drug as treatment of choice ( odds ratio , 5.3 ; 95 % confidence interval , 2.0 - 14.4 ) compared with trials funded by nonprofit organizations . This association did not appear to reflect treatment effect or adverse events . CONCLUSIONS Conclusions in trials funded by for-profit organizations may be more positive due to biased interpretation of trial results . Readers should carefully evaluate whether conclusions in r and omized trials are supported by data BACKGROUND Major depression is highly recurrent . Antidepressant maintenance treatment has proven efficacy against recurrent depression . AIMS Comparison of prophylactic efficacy of citalopram versus placebo in unipolar , recurrent depression . METHODS Patients 18 - 65 years of age with recurrent unipolar major depression ( DSM-IV ) , a Montgomery-Asberg Depression Rating Scale score of > or = 22 and two or more previous depressive episodes , one within the past 5 years , were treated openly with citalopram ( 20 - 60 mg ) for 6 - 9 weeks and , if responding , continued for 16 weeks before being r and omised to double-blind maintenance treatment with citalopram or placebo for 48 - 77 weeks . RESULTS A total of 427 patients entered acute treatment and 269 were r and omised to double-blind treatment .  Time to recurrence was longer in patients taking citalopram than in patients taking placebo ( P:<0.001 ) . Prophylactic treatment was well tolerated . CONCLUSIONS Citalopram ( 20 , 40 and 60 mg ) is effective in the prevention of depressive recurrences .  Patients at risk should continue maintenance treatment at the dose necessary to resolve symptoms in the acute treatment phase Anecdotal and published case reports suggest that some patients taking selective serotonin reuptake inhibitors ( SSRI )  experience diminution in emotional responsiveness . This study aims to define the individual components of emotion disturbed in these patients . Fifteen patients reporting SSRI-induced sexual dysfunction completed the Laukes Emotional Intensity Scale  ( LEIS ) , a question naire about various emotions . Compared to controls , patients reported significantly ( p<0.05 ) less ability to cry , irritation , care about others ' feelings , sadness , erotic dreaming , creativity , surprise , anger , expression of their feelings , worry over things or situations , sexual pleasure , and interest in sex . Total score on the LEIS did not correlate with total score on the Hamilton Depression Rating Scale . In our sample , 80 % of patients with SSRI-induced sexual dysfunction also describe clinical ly significant blunting of several emotions . Emotional blunting may be an under-appreciated side-effect of SSRIs that may contribute to treatment non-compliance and /or reduced quality of life ABSTRACT — In a double‐blind trial , comprising 96 depressed patients , citalopram was compared with maprotiline . The trial period was 6 weeks with ratings ( MADRS , CGI ) and side effects recordings taking place at Weeks 0 , 1 , 2 , 4 , and 6 . Both drugs were administered as a single evening dose , 40 or 60 mg for citalopram , and 75 or 150 mg for maprotiline .  MADRS total scores and CGI scores showed a highly significant reduction in both groups with no significant difference between them , whether the groups were considered as a whole or whether they were subdivided into endogenously/non‐endogenously depressed or melancholic/non‐melancholic patients . Side effects were not significantly different , but the maprotiline group showed more anticholinergic side effects , whereas the citalopram group showed more nausea , increased sweating and headache . Two patients on maprotiline were withdrawn because of side effects ( hypotension and somnolence in the one case ; tremor and insomnia in the other ) . One patient in each group was withdrawn because of increased transaminases , the citalopram‐treated patient having increased values , however , already at baseline . Apart from this , no cardiovascular side effects and no pathological laboratory values related to treatment were observed . The authors conclude that citalopram is a safe antidepressant drug and as effective as maprotiline Selective serotonin reuptake inhibitors ( SSRIs ) have been reported to be useful in the treatment of  depression in patients with Parkinson 's disease ( PD ) . However , a few reports have suggested that SSRIs may worsen parkinsonian motor symptomatology and extrapyramidal side effects have been reported in depressed patients treated with SSRIs . So far , no prospect i ve trial comparing the effects of different SSRIs in depressed patients with PD has been performed . The aim of the present study was to assess the effects of four SSRIs ( citalopram , fluoxetine , fluvoxamine , and sertraline ) on motor performance and their efficacy on depression in a group of patients with PD . Sixty-two consecutive nondemented , nonfluctuating , depressed patients with PD were included in four treatment groups ( 15 patiens received citalopram , 16 fluoxetine , 16 fluvoxamine , and 15 sertraline ) . The evaluation of extrapyramidal and depressive symptomatology was performed with use of the Unified Parkinson 's Disease Rating Scale ( UPDRS ) , Beck Depression Inventory , and Hamilton Depression Rating Scale at baseline and after 1 , 3 , and 6 months . Fifty-two patients completed the study .  UPDRS scores were not significantly modified by the add-on therapy with each of the SSRIs studied . A significant improvement in depressive symptoms from baseline to the end of the trial was obtained with all SSRIs ( Beck and Hamilton scores improving;p < 0.05 according to an analysis of variance ) . Our findings suggest that SSRIs do not significantly worsen extrapyramidal symptomatology and may ameliorate depression in patients with PD BACKGROUND Antidepressants exhibit a variety of pharmacological actions including inhibition of the serotonin and noradrenaline transporters . We wished to investigate whether genetic variation could be used to target or personalise treatment , in a comparison of selective serotonin reuptake inhibitors ( SSRIs ) with noradrenaline re 
    Output:
    
agent
Some statistically significant differences between citalopram and other antidepressants for the acute phase treatment of major depression were found in terms of efficacy , tolerability and acceptability .
Citalopram was more efficacious than paroxetine and reboxetine and more acceptable than tricyclics , reboxetine and venlafaxine , however , it seemed to be less efficacious than escitalopram .
***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: Background Alcohol dependence comorbid with major depressive disorder poses a major challenge in the clinical setting . The results in the treatment with selective serotonin re-uptake inhibitors have been conflicting . Thus , we compared in alcohol-dependent patients with co-morbid major depressive disorder the selective serotonin re-uptake inhibitor escitalopram to a compound that acts on different transporter system and may reduce craving , the glutamate receptor antagonist memantine . Methods Eighty alcohol-dependent patients comorbid with major depressive disorder in municipal alcohol clinics were r and omized 1:1 to receive memantine 20 mg or escitalopram 20 mg in a double-blind manner . During the 26-week study period patients continued their routine treatment at the clinics . Abstinence was not required but encouraged . The patients attended visits weekly during the first month , and then at 3 and at 6 months . Outcome measures were Alcohol Use Disorders Identification Test ( AUDIT ) , Obsessive Compulsive Drinking Scale ( OCDS ) and Drinking Diary . Results The completion rate was high in both groups , especially among the patients who had been abstinent at the beginning of the study . However , among those patients who were not abstinent at baseline , 47 % in both groups discontinued the study . Numbers of abstinent days were high in both groups throughout the study . Alcohol consumption measured by the AUDIT QF ( quantity-frequency ) score was significantly reduced in both groups , as was the craving for alcohol measured by the OCDS . Early age at first alcohol intoxication predicted poor treatment outcomes in patients treated with escitalopram , and the same was seen with the early onset of the first depressive episode . The same predictive effects were not found in patients treated with memantine . Conclusion Our results indicate that both memantine and escitalopram are useful adjunct medications for the treatment of alcohol dependence co-morbid with major depression . Memantine was at least as effective with regard to drinking as escitalopram . We believe that a direct comparison of memantine , with the commonly used escitalopram , can provide useful information for clinicians on the treatment of alcohol dependency co-morbid with MDD.Trial registration Clinical Trials.gov Identifier # Abstract The selective serotonin reuptake inhibitor citalopram was compared with clomipramine in a multicenter clinical study . From a total of 150 depressed patients ( age 18–65 years ) , 114 patients with a Hamilton Depression Scale ( HDS ) total score≧18 at the end of a 1 week placebo period were started on treatment with either citalopram ( 40 mg/day ) or clomipramine ( 150 mg/day ) ( fixed , single daily dose ) . Patients stratified according to diagnostic rating ( Newcastle Inventory , endogenous/non-endogenous ) were r and omly allocated to treatment groups using double blind principles . In total , 102 patients completed more than 2 weeks , treatment and were included in the analyses of therapeutic effect . The two drug groups were comparable in terms of sex , age , and departmental distribution . Categorical measurements of therapeutic effect based on the HDS total score showed that in the endogenously depressed patients a significantly higher percentage of patients on clomipramine ( n=37 ) than on citalopram ( n=38 ) were classified as complete responders ( HDS total≦7 ) after 3 , 4 and 5 weeks of treatment . In the non-endogenously depressed patients ( clomipramine : n=15 , citalopram : n=12 ) rather similar numerical differences were observed ( P<0.05 at 5th week ) . In the total patient group the percentage of complete response after 5 weeks was about 60 in the clomipramine group ( n=52 ) and about 30 in the citalopram group ( n=50 ) ( P<0.005 ) . The better effect of clomipramine seemed to be related in particular to the sleep items , but other items covering depression , retardation and anxiety/agitation also contributed to the difference in total score that was also seen in patients with low initial scores on the sleep items . Citalopram was devoid of the typical autonomic side effects and orthostatic hypotension seen with clomipramine . Symptoms of nausea/vomiting and headache became somewhat worse in the citalopram- and somewhat better in the clomipramine-treated patients . Participating centers:1Department of Psychiatry , Odense University Hospital , Odense , 2Department of Psychiatry , Rigshospitalet , University of Copenhagen , Copenhagen , 3Departments of Psychiatry , Frederiksborg General Hospital , Hillerød , 4Department A and C , Psychiatric University Hospital , Århus , 5Department of Psychiatry , Bornholm General Hospital , Rønne , 6Department of Clinical Pharmacology , Odense University , Odense Participating clinicians : J. And ersen2 , P. Bech2,3 , S. Benjaminsen1 , M. Bjerre1 , S. Bøjholm5 , P. Christensen1 , A. Gjerris2 , L. Hansted4 , E. Jensen3 , P. Kragh-Sørensen1 , C.B. Kristensen1,3 , P. Kyneb4 , D. Loldrup3 , O.F. Madsen4 , O.L. Pedersen1 , O.J. Rafaelsen2 , S. Rasmussen3 , N. Reisby4 , F. Sevaj3 , P. Simonsen4 , H.Y. Thomsen1 , P. Vestergaard4Coordination and drug assay : L.F. Gram6Statistical consultants : O. Aaskoven , P. Allerup Data - collection and -processing : C. Sánchez Steering Committee : P. Bech , L.F. Gram ( chairman ) , P. Kragh-Sørensen , O.J. Rafaelsen , N. Reisby , P. CONTEXT Previous studies indicate that industry-sponsored trials tend to draw proindustry conclusions . OBJECTIVE To explore whether the association between funding and conclusions in r and omized drug trials reflects treatment effects or adverse events . DESIGN Observational study of 370 r and omized drug trials included in meta-analyses from Cochrane review s selected from the Cochrane Library , May 2001 . From a r and om sample of 167 Cochrane review s , 25 contained eligible meta-analyses ( assessed a binary outcome ; pooled at least 5 full-paper trials of which at least 1 reported adequate and 1 reported inadequate allocation concealment ) . The primary binary outcome from each meta- analysis was considered the primary outcome for all trials included in each meta- analysis . The association between funding and conclusions was analyzed by logistic regression with adjustment for treatment effect , adverse events , and additional confounding factors ( method ological quality , control intervention , sample size , publication year , and place of publication ) . MAIN OUTCOME MEASURE Conclusions in trials , classified into whether the experimental drug was recommended as the treatment of choice or not . RESULTS The experimental drug was recommended as treatment of choice in 16 % of trials funded by nonprofit organizations , 30 % of trials not reporting funding , 35 % of trials funded by both nonprofit and for-profit organizations , and 51 % of trials funded by for-profit organizations ( P<.001 ; chi2 test ) . Logistic regression analyses indicated that funding , treatment effect , and double blinding were the only significant predictors of conclusions . Adjusted analyses showed that trials funded by for-profit organizations were significantly more likely to recommend the experimental drug as treatment of choice ( odds ratio , 5.3 ; 95 % confidence interval , 2.0 - 14.4 ) compared with trials funded by nonprofit organizations . This association did not appear to reflect treatment effect or adverse events . CONCLUSIONS Conclusions in trials funded by for-profit organizations may be more positive due to biased interpretation of trial results . Readers should carefully evaluate whether conclusions in r and omized trials are supported by data BACKGROUND Major depression is highly recurrent . Antidepressant maintenance treatment has proven efficacy against recurrent depression . AIMS Comparison of prophylactic efficacy of citalopram versus placebo in unipolar , recurrent depression . METHODS Patients 18 - 65 years of age with recurrent unipolar major depression ( DSM-IV ) , a Montgomery-Asberg Depression Rating Scale score of > or = 22 and two or more previous depressive episodes , one within the past 5 years , were treated openly with citalopram ( 20 - 60 mg ) for 6 - 9 weeks and , if responding , continued for 16 weeks before being r and omised to double-blind maintenance treatment with citalopram or placebo for 48 - 77 weeks . RESULTS A total of 427 patients entered acute treatment and 269 were r and omised to double-blind treatment .  Time to recurrence was longer in patients taking citalopram than in patients taking placebo ( P:<0.001 ) . Prophylactic treatment was well tolerated . CONCLUSIONS Citalopram ( 20 , 40 and 60 mg ) is effective in the prevention of depressive recurrences .  Patients at risk should continue maintenance treatment at the dose necessary to resolve symptoms in the acute treatment phase Anecdotal and published case reports suggest that some patients taking selective serotonin reuptake inhibitors ( SSRI )  experience diminution in emotional responsiveness . This study aims to define the individual components of emotion disturbed in these patients . Fifteen patients reporting SSRI-induced sexual dysfunction completed the Laukes Emotional Intensity Scale  ( LEIS ) , a question naire about various emotions . Compared to controls , patients reported significantly ( p<0.05 ) less ability to cry , irritation , care about others ' feelings , sadness , erotic dreaming , creativity , surprise , anger , expression of their feelings , worry over things or situations , sexual pleasure , and interest in sex . Total score on the LEIS did not correlate with total score on the Hamilton Depression Rating Scale . In our sample , 80 % of patients with SSRI-induced sexual dysfunction also describe clinical ly significant blunting of several emotions . Emotional blunting may be an under-appreciated side-effect of SSRIs that may contribute to treatment non-compliance and /or reduced quality of life ABSTRACT — In a double‐blind trial , comprising 96 depressed patients , citalopram was compared with maprotiline . The trial period was 6 weeks with ratings ( MADRS , CGI ) and side effects recordings taking place at Weeks 0 , 1 , 2 , 4 , and 6 . Both drugs were administered as a single evening dose , 40 or 60 mg for citalopram , and 75 or 150 mg for maprotiline .  MADRS total scores and CGI scores showed a highly significant reduction in both groups with no significant difference between them , whether the groups were considered as a whole or whether they were subdivided into endogenously/non‐endogenously depressed or melancholic/non‐melancholic patients . Side effects were not significantly different , but the maprotiline group showed more anticholinergic side effects , whereas the citalopram group showed more nausea , increased sweating and headache . Two patients on maprotiline were withdrawn because of side effects ( hypotension and somnolence in the one case ; tremor and insomnia in the other ) . One patient in each group was withdrawn because of increased transaminases , the citalopram‐treated patient having increased values , however , already at baseline . Apart from this , no cardiovascular side effects and no pathological laboratory values related to treatment were observed . The authors conclude that citalopram is a safe antidepressant drug and as effective as maprotiline Selective serotonin reuptake inhibitors ( SSRIs ) have been reported to be useful in the treatment of  depression in patients with Parkinson 's disease ( PD ) . However , a few reports have suggested that SSRIs may worsen parkinsonian motor symptomatology and extrapyramidal side effects have been reported in depressed patients treated with SSRIs . So far , no prospect i ve trial comparing the effects of different SSRIs in depressed patients with PD has been performed . The aim of the present study was to assess the effects of four SSRIs ( citalopram , fluoxetine , fluvoxamine , and sertraline ) on motor performance and their efficacy on depression in a group of patients with PD . Sixty-two consecutive nondemented , nonfluctuating , depressed patients with PD were included in four treatment groups ( 15 patiens received citalopram , 16 fluoxetine , 16 fluvoxamine , and 15 sertraline ) . The evaluation of extrapyramidal and depressive symptomatology was performed with use of the Unified Parkinson 's Disease Rating Scale ( UPDRS ) , Beck Depression Inventory , and Hamilton Depression Rating Scale at baseline and after 1 , 3 , and 6 months . Fifty-two patients completed the study .  UPDRS scores were not significantly modified by the add-on therapy with each of the SSRIs studied . A significant improvement in depressive symptoms from baseline to the end of the trial was obtained with all SSRIs ( Beck and Hamilton scores improving;p < 0.05 according to an analysis of variance ) . Our findings suggest that SSRIs do not significantly worsen extrapyramidal symptomatology and may ameliorate depression in patients with PD BACKGROUND Antidepressants exhibit a variety of pharmacological actions including inhibition of the serotonin and noradrenaline transporters . We wished to investigate whether genetic variation could be used to target or personalise treatment , in a comparison of selective serotonin reuptake inhibitors ( SSRIs ) with noradrenaline re 
    Output:
    