Table 3 Experts' ratings: Choice of antidepressant
From: Expert opinion on detecting and treating depression in palliative care: A Delphi study
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Drug
0 = not useful, 10 = very useful | Experts comments |
|---|---|
|
Mirtazapine
Round 1: Median 9.0 (7-10); n = 11 Round 2: Median 9.0 (7-10); n = 11 |
-Some data, good profile regarding side effects, at this time most used -Seems well tolerated -When side effects on sleep and appetite are handy -Too soft -Has useful sedative properties and well tolerated -My first-line - evidence is that it is more effective than SSRIs and appetite stimulant and sedative qualities are useful side effects |
|
Citalopram
Round 1: Median 9.0 (5-10); n = 11 Round 2: Median 9.0 (5-10); n = 13 | -Side effects due to its antIHJJistaminic action |
|
Venlafaxine
Round 1: Median 7.5 (0-10); n = 8 Round 2: Median 8.0 (0-9); n = 13 |
-Less side effects than tricyclics -Useful if patient needs help for sedation -If depression is associated with chronic high level of anxiety -Not straightforward - discontinuation symptoms common. Cardiac toxicity |
|
Sertraline
Round 1: Median 7.0 (2-10); n = 11 Round 2: Median 7.5 (0-10); n = 12 |
-Favourable side effect profile -Interaction with dopamine system could give different and more side effects than other SSRIs -Least adverse effects, presently best available |
|
Escitalopram
Round 1: Median 8.0 (0-10); n = 10 Round 2: Median 7.0 (0-10); n = 13 |
-Not cost effective alternative to citalopram -Better tolerated than R-citalopram and less interaction with cytocrome 450 2D6 |
|
Amitriptyline
Round 1: Median 5.0 (1-9); n = 10 Round 2: Median 4.0 (0-8); n = 12 |
-Side-effects -Too sedative, effect too delayed, frequent compliance obstacle due to side effects -If indicated for neuropathic pain -For individual TCAs I don't think there is sufficient evidence to differentially rate, although clinically I would favour those drugs that are used most often in palliative care anyway e.g. amitriptyline -An excellent antidepressant |
|
Paroxetine
Round 1: Median 5.5 (0-9); n = 10 Round 2: Median 3.0 (0-7); n = 13 |
-Too many pharmacological interactions -Interactions and withdrawal problems -No place - withdrawal syndrome |
|
Fluoxetine
Round 1: Median 3.0 (0-6); n = 10 Round 2: Median 3.0 (0-6); n = 13 |
-Too long half time, not useful for physically ill people -Long t1/2 and interactions -Too disinhibitory, but not better antidepressant than other SSRIs |
|
Imipramine
Round 1: Median 5.0 (0-6); n = 7 Round 2: Median 2.0 (0-8); n = 11 | -Just in patients with depressive history who have already utilized before |
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Nortriptyline
Round 1: Median 2.0 (0-9); n = 9 Round 2: Median 2.0 (0-7); n = 11 |
-If indicated for neuropathic pain -Less than amitriptyline |
|
Mianserin
Round 1: Median 5.0 (0-9); n = 7 Round 2: Median 0.0 (0-7); n = 11 |
-Little used in practice compared with other drugs and little evidence available -No point really - it is pharmacologically similar to mirtazapine, which doesn't hit the white cells |
