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Efficacy of tianeptine in
major depressive disorders
with or without melancholia.
Ginestet D
Psychiatry Department,
Groupe Hospitalier Paul Brousse, Villejuif, France.
Eur Neuropsychopharmacol 1997 Oct;7 Suppl 3:S341-5
ABSTRACT
The efficacy of tianeptine in the treatment of
major depressive episodes was assessed in three double-blind
placebo-controlled studies. In a first double-blind study comparing tianeptine
(37.5 mg/day) with placebo, 126 patients with Major Depression or a Depressed
Bipolar Disorder were treated for 42 days; 60% of these patients fulfilled
DSM-III-R criteria for melancholia. Final MADRS scores showed the efficacy of
tianeptine in comparison with placebo (P = 0.007). This result was confirmed
by the time course of the Severity of Illness (CGI item 1) (P = 0.015). 58% of
the patients responded to tianeptine versus 41% to placebo. In another study
comparing tianeptine (37.5 mg/day), imipramine (150 mg/day), and placebo, 186
depressed patients were treated for 42 days. The patients had either Major
Depression or Depressed Bipolar Disorder, without melancholia (DSM III-R). In
the intention-to-treat analysis, final MADRS scores showed a better efficacy
of tianeptine and imipramine than placebo (P = 0.012 and P = 0.034,
respectively). There were 56% responders on tianeptine vs 48% on imipramine,
and 32% on placebo. A third study involved 244 patients with Major Depression
with or without melancholia (DSM-III-R). They were treated in a parallel group
design with tianeptine (37.5 mg/day) or tianeptine (75 mg/day) or placebo for
42 days. The high rate of placebo-responders (> 65%) did not allow any
conclusion about the efficacy of tianeptine. Altogether, tianeptine was shown
to be an effective and safe medication for the treatment of major depressive
episodes. However, a controlled study in endogenous depression would be useful
to determine the position of tianeptine among the other antidepressants in
this indication.
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