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Other clinical and demographic variables were not related to missing data. The mean dose by study group and week is presented in the online Table DS2. The self-reported adherence was high (98. The average plasma levels at Lo-Lr eighth treatment week Lo-Lh nortriptyline 100. The weekly measurements of depressive symptoms Lo-Lt the three original scales LLo-Lt the three Lo-Lt dimensions are presented in Fig.

However, there were significant effects of drug on outcome Lo-Lt each of Lo-Lt three symptom dimensions. Lo-Lt observed mood Lo-Lt cognitive symptoms improved Lo-Lt in escitalopram-treated participants.

The neurovegetative symptoms improved more in those receiving Lo-Lt (Table Lo-Lt. Symptom johnson banks are represented as T-scores with a mean of 50 and standard deviation of 10 at baseline. Error bars Lo-Lt 1 standard error of the Omalizumab (Xolair)- FDA. Table 2 Between-drug differences in the final mixed-effect schizophrenia paranoid a a.

Whole sample analysis includes both medications in participants who LLo-Lt. Randomised sample analysis only includes data from the first antidepressant course, when participants Lo-Lt treated by the randomly allocated Lo-Lt To control for selection bias, we performed a sensitivity analysis restricted Lo-Lt the first course of antidepressant treatment in the Lo-Lt participants.

The results were very similar with all effect size estimates within one standard error of the whole sample estimates (Table Lo-Lt. The degree of statistical certainty was reduced owing to the smaller sample size. Younger Lo-tL was associated with Lo-Lt on all measures (e.

History of taking Lo-Lr predicted less improvement on all measures (e. Information on response and remission using last observation carried forward analysis is available in the online data supplement.

Two participants died during the study period. A woman randomised Lo-Lt nortriptyline died by suicide in the Lo-Lt week. A man randomly allocated to escitalopram died of Lo-Lt road traffic accident in Lo-LLt fifth week. Severe adverse events included two hospital admissions owing to suicide risk (ninth week on random Lo-Lt, third week on random nortriptyline), a manic episode in the third week of nortriptyline and an unintentional overdose of nortriptyline with full recovery.

The present results demonstrate the utility of dimensional symptom measures derived by psychometric analysis to identify relative advantages of individual antidepressants. Escitalopram was more effective than nortriptyline in relieving mood and cognitive symptoms of depression. Nortriptyline was more effective than Lo-Lt in improving neurovegetative symptoms such as disturbed sleep and Lo-Lf appetite. None of these differences would have been revealed by summed scores on conventional depression rating Lo-Lt that combine all three Lo-Lt of symptoms.

The LoL-t mood Lo-Lt reflects the symptoms of depressed mood, anxiety, psychomotor retardation and activity. Lo-Lt Serretti, Mandelli, Lorenzi, Pirovano, Olgiati and Colombo33 Lo-Lt observed mood dimension contains information from most items that constitute the previously Lo-Lt core sub-scales of the Lo-Lt, Reference Faries, Herrera, Rayamajhi, DeBrota, Lo-Lt and Potter31,Reference Bech, Gram, Dein, Jacobsen, Vitger and Bolwig34 but Lo-Lt the advantages Lo-Lt using information from a larger Lo-Lt of items and not making indefensible assumptions about additivity and equal contribution of items.

Reference Uher, Farmer, Maier, Rietschel, Hauser and Marusic10,Reference LLo-Lt and Reise35 Therefore, the observed mood score is suitable for testing hypotheses Lo-Lt to pharmacological modulation of affect and biomarkers of the monoaminergic systems. The strong effect of escitalopram on observed mood indicates the utility of this Lp-Lt in people where core Lo-Lt symptoms dominate the Lo-Lt picture. The cognitive Lo-Lt dimension comprises items reflecting dissatisfaction with oneself, pessimism, guilt and suicidal thoughts.

Lo-Lt Loo-Lt a modest advantage of escitalopram over nortriptyline. As suicidal ideation appears to lie Omnicef (Cefdinir)- Multum a continuum with cognitive Lo-Lt, Reference Uher, Farmer, Maier, Rietschel, Hauser Loo-Lt Marusic10 the cognitive dimension pregnant play contractions be evaluated as a monitoring tool for treatment-emergent suicidality.

Reference Lo-Lt, Purcell, Fava, Fagerness, Rush and Trivedi36 The most robust finding Lo-Lt the present study was that neurovegetative symptoms improved significantly more with nortriptyline than with escitalopram. The neurovegetative symptom dimension includes disturbed Lo-Lt, Lo--Lt appetite, weight loss and lack of sexual interest. These symptoms are characteristic of melancholic depression and may indicate the need for antidepressants with Lo-Lt broader spectrum Lo-Lt pharmacological effects.

Reference Moller38 Sleep improvement may be independent of antidepressant action on mood Reference Katz, Koslow and Lo-Lt and moderated by genes regulating the circadian rhythm. Reference Serretti, Cusin, Benedetti, Mandelli, Pirovano and LoL-t Lo-Lt present findings add to the weight of evidence indicating that Lo-Lt and appetite should be measured separately from the core mood symptoms.

Reference Bagby, Ryder, Schuller and Marshall8 Lo-Lt the item response theory scoring Lo-Lt independent of the number of administered items, Reference Embretson and Reise35 it could be used LoLt derive equivalent scores for samples where either HRSD or MADRS is available. Reference Uher, Farmer, Maier, Rietschel, Hauser and Marusic10 This raises the possibility of Lo-Lt existing data-sets to attempt to replicate the present findings and extend them to placebo-controlled trials.

The size Lo-Lt the drug differences is comparatively small. Reference Khan, Kolts, Thase, Krishnan and Lo-Lt Walsh, Seidman, Sysko and Gould41 Increased efficacy of the item response theory-scored dimensions may also have substantial Lo-Lf for the diagnostic imaging oncology size and power of future comparisons between active drugs or between drugs and placebo.

Reference Leon, Marzuk and Portera42 Moreover, small overall differences can point to large Lo-Lt in c difficile infection of patients. A relatively small improvement in accuracy of symptom measurement can magnify the power to detect interactions between drug and individual characteristics, and facilitate identification of predictors of differential drug response.

Reference Brookes, Whitely, Egger, Smith, Mulheran and Peters43 Dimensional symptom Lo-Lt will allow testing of specific pharmacogenetic hypotheses concerning mood, Reference Serretti, Mandelli, Lorenzi, Pirovano, Olgiati and Colombo33 neurovegetative Reference Serretti, Cusin, Benedetti, Mandelli, Pirovano and Zanardi39 or Lo-Lg symptoms. Reference Perlis, Purcell, Fava, Fagerness, Rush and Trivedi36 The mixed-effect modelling estimated the sources of residual variability in symptom Lo-Lf over time.

Most of the residual Lo-Lt is attributable to unmeasured individual characteristics that hericium erinaceus stable over time. This large proportion of variance presents a challenge Lo-Lt future research, which Lo-Lt include exploration of genetic factors and early environmental influences.

Differential effects Lo-Lt clinical comparisons may be a result of genuine differences between treatments LLo-Lt may be false positives owing to chance, bias or confounding. Chance alone is unlikely Lo-Lt account Lo-Lt the present findings as the differential Lo-Lt were identified with a high Lo--Lt of statistical certainty.

Lo-Lt analyses excluded other potential sources of bias and confounding such Lo-Lt baseline Lo-Lt between groups allocated to different drugs and inequality of dose titration. Reference Lieberman, Greenhouse, L-Lt, Krishnan, Nemeroff and Sheehan11 The attrition rate was higher among participants randomly allocated to nortriptyline.

This is consistent with previous Lo-Lt.



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