A comparative study on efficacy of amitriptyline and escitalopram in the treatment of depression

Background: Several generations of antidepressant medication which act by distinct pharmacological mechanisms have been introduced for the treatment of depression; tricyclic antidepressants (TCAs) were first line of treatment for many years. However, over the last decade, selective serotonin reuptake inhibitors (SSRIs) have displaced TCAs, mainly because of better side effect profile. There are no references in literature on comparison of efficacy of TCAs and SSRIs in Nepalese population. This study attempted to compare the efficacy of amitriptyline, a reference standard TCA with escitalopram, a newer SSRI in Nepalese population.Methods: An open level, randomised, prospective study was conducted for one year duration. Eighty outpatients suffering from major depression who met inclusion and exclusion criteria were randomly assigned to either amitriptyline or escitalopram group for four week study. Seventy one patients (amitriptyline N: 36, escitalopram N: 35) completed the study. Hamilton Depression Rating Scale (HDRS) was used to measure the antidepressant effect. Antidepressant efficacy was evaluated on reduction of HDRS score before and after therapy (End of four weeks).Results: In amitriptyline group, mean percentage reduction in HDRS score was 58.29% (13.5 points), while in escitalopram group was 60.78% (14.03 points). Both the drugs significantly improved the HDRS score at the end of the study (p<0.05). On intergroup comparison, antidepressant efficacy of amitriptyline and escitalopram did not differ significantly from each other (p>0.05).Conclusions: This study suggests that escitalopram is effective in the treatment of depression and its efficacy appears to be comparable to amitriptyline at the end of four weeks.

Thyroid function in depression.

Studies on thyroid functions were performed on patients suffering from depression. Thirty four cases of depression were studied for their thyroid function and showed a diminished level of T3 and T4 with concomitant rise in TSH (Thyroid Stimulating Hormone) level. This work showed that depressive patients had been suffering from sub-hypothyroidism.

Retrospective study of suicide cases admitted in Nepal Medical College Teaching Hospital.

A retrospective study of suicide cases admitted to Emergency Department and latter admitted to Department of Medicine and followed by Department of Psychiatry, Nepal Medical College Teaching Hospital. This study covered a period of 4 yrs. i.e. from January 2000 to December 2003. During this period total 118 cases were admitted. Out of which 39 male and 58 female cases were studied. Suicide was their common motive. The most common poison was organophosphorous compounds. Age group of attempt suicide are between 15-45 yrs. Depression, post-schizophrenic depression and clear psychosocial stress were important cause of suicide in this study.

Study on etiological factors on mental retardation in Kathmandu.

The study of etiological factors on mental retardation was conducted at family counselling and resource school of Association of Welfare of Menta+lly Retarded (AWMR), Hattisar, Kathmandu. A total of 91 mental retarded cases were studied in the year 2000 and 2001 for etiological factors. The present study shows significant relationship of mental retardation and age in both the year. The higher rate of mental retardation in the 0 to 5 years age group in both the year. About 70.0% with mental retardation (MR) are first born babies in both the year. Majority of the families have unfavourable attitude towards the mentally retarded individual.