This study discusses the diagnosis and treatment of depressive disorders, including (but not limited to) major depressive disorder, severe depression, melancholic depression, and endogenous depression. They also compared the efficacy of both SSRIs and TCAs (tricyclic antidepressants). However, it was hard to directly compare the two, as there is no optimal dose for SSRIs, despite the defined optimal dose existing for TCAs.

Both treatment options also have a risk of discomforting side effects, such as (but not limited to):  vomiting, dry mouth, and constipation. Altogether, there was not a significant difference in efficacy and adverse reactions between TCAs and SSRIs, but it was acknowledged that more severe subtypes of depressive disorder were more responsive to higher doses. 

Conclusions of the Study

Responses to the antidepressants (for either type) were understood using the HAM-D rating. Severe depression is diagnosable at a score of 25+ points; a notable response to the antidepressant is defined as at least a 50% reduction in the HAM-D score. This, however, does not recognize that someone who reduces their score from 30 points to 15 points may still experience heavily-impairing symptoms, which require further treatment.

Limitations to the Antidepressant Response Measurement

Hirschfeld, R. M. (1999). Efficacy of SSRIs and newer antidepressants in severe depression: comparison with TCAs. Journal of Clinical Psychiatry, 60(5), 326-335.

Rutgers University

Halbreich, U. (2008). Selective serotonin reuptake inhibitors and initial oral contraceptives for the treatment of PMDD: effective but not enough. CNS spectrums, 13(7), 566-572.

SSRIs and Initial Oral Contraceptives for the Treatment of PMDD

This study investigated the efficacy of both Selective Serotonin Reuptake Inhibitors (SSRIs) and Combined Oral Contraceptives (COCs), which are commonly seen as treatment options  for Premenstrual Dysphoric Disorder (PMDD) and Premenstrual Syndrome (PMS).

When looking into the reports of patients who are specifically being treated for PMDD, researchers found that neither treatment option sufficiently improves the disorder. While many patients do see improvement in their symptoms, there was never a report of a patient who no longer met, or significantly reduced, the diagnostic criteria for PMDD (based on the DSM-IV).

Additionally, there was not a very strong difference in percentage of people who responded to either treatment method (65%) in comparison to those who responded to the placebo (49%), meaning that the efficacy of these treatments could be largely due to the placebo effect and the idea of being treated, rather than the medications themselves. After accounting for the placebo effect, researchers recognized that there is actually a lower percentage of people who DO respond to the treatments (36%) than those who have no response at all (35% to 47%).

Ultimately, this research concludes that SSRIs and COCs can be potential options, but are not sufficient enough treatment methods for those with either PMS or PMDD. 

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