The efficacy and tolerability of dothiepin and three selective serotonin reuptake inhibitors in the treatment of major depression: A review of six double-blind studies

Abstract

The introduction of the selective serotonin reuptake inhibitors (SSRIs) in the treatment of depression has highlighted some of the limitations of the more established tricyclic antidepressants (TCAs). There are six recently published studies that compare the efficacy and tolerability of the SSRIs fluvoxamine, fluoxetine, and paroxetine with the TCA dothiepin. The results of these studies indicate that SSRIs do not have more potent antidepressant properties than dothiepin, nor exhibit a faster onset of antidepressant effect; indeed, premature withdrawal from treatment due to adverse events was more frequent with SSRIs than with dothiepin. Although the frequency of side effects not resulting in withdrawal was similar with SSRIs and dothiepin, the spectrum of such events was different. Dothiepin was associated with more anticholinergic effects, notably dry mouth, drowsiness, and blurred vision, whereas SSRIs were associated with a greater incidence of nausea, rash, and sweating. The present review shows that certain perceived advantages of SSRIs over TCAs may not be borne out in clinical practice, particularly in comparisons with dothiepin.