THERAPEUTIC EFFICACY OF ANTIDEPRESSANTS IN AGITATED ANXIOUS DEPRESSION - A METAANALYSIS OF MOCLOBEMIDE STUDIES

The results of the meta-analysis of studies comparing the efficacy of moclobemide, imipramine and so-called sedative antidepressants (amitri ptyline, mianserin and maprotiline) in 2416 patients are described. Th e results demonstrated that in agitated-anxious depressive patients (d efined by HAMD factor score or HAMD item 9) a nonsedative, reversible MAO-A inhibitor moclobemide has about equal efficacy as imipramine or sedative antidepressants. All antidepressants were clearly superior to placebo, irrespective of the outcome measures applied (> 50% HAMD dec rease, CGI improvement). The efficacy of antidepressants in agitated p atients was unrelated to the severity of agitation and did not appear to be inferior to the efficacy in nonagitated patients. Comedication w ith benzodiazepines had no impact on overall efficacy of either moclob emide or other antidepressants in this patient population. Previous tr eatment with antidepressants, however, always negatively influenced th e outcome with trial drugs, e.g., reduced their efficacy. Placebo resp onse in agitated depressives appeared generally to be low (20-30%) and was clearly reduced with increased severity of agitation, irrespectiv ely of how the agitation was defined.