Economic outcomes associated with tricyclic antidepressant and selective serotonin reuptake inhibitor treatments for depression

Objective: To compare the economic outcomes associated with the tricyclic a ntidepressants (TCAs) and the selective serotonin reuptake inhibitors (SSRI s) in the treatment of depression. Method: A literature review of pertinent studies was performed. The advanta ges and disadvantages of clinical trials versus observational studies are d escribed, and the breadth of the economic outcome measure chosen for the co nclusions reached is discussed. Results: The inclusion and exclusion criteria of clinical trials, in combin ation with their strict provider and patient study protocols, limit their g eneralizability to naturalistic treatment settings. Retrospective studies o f patients can provide valuable information about the experiences and costs incurred by patients in actual treatment. However, confounding factors (bo th observable and unobservable) limit the amount of confidence that can be placed in inferences about treatment effects. Randomized prospective studie s with naturalistic follow-on may help to mitigate some of the concern abou t treatment confounders which has traditionally been associated with non-ra ndomized observational studies. Conclusion: Retrospective studies and one randomized prospective study of t he economic outcomes of TCA versus SSRI treatment have found the SSRIs to b e less expensive than TCAs when total direct medical expenditures are consi dered. However, additional studies are needed to address this issue.