Radon in spring waters in the south of Catalonia.

Spring waters in the south of Catalonia were analysed to determine the (222)Rn activity in order to be able to establish a correlation between the obtained values with the geology of the area of origin of these samples, and also estimate the potential health risks associated with (222)Rn. Most of the analysed samples (90%) show (222)Rn activities lower than 100Bq/L (exposure limit in water recommended by the World Health Organisation and EU directive 2013/51/EURATOM). However, in some cases, the activity values found for this isotope exceeded those levels and this can be attributed to the geology of the area where the spring waters are located, which is predominantly of granitic characteristics. To verify the origin of the radon present in the analysed samples, the obtained activity values were compared with the activities of its parents ((226)Ra, (238)U and (234)U). Finally, we have calculated the annual effective dose from all the radionuclides measured in spring water samples. The results showed that the higher contribution due to spring water ingestion come from (222)Rn and (226)Ra. The resulting contribution to the annual effective dose due to radon ingestion varies between 10.2 and 765.8 µSv/y, and the total annual effective dose due to his parents, (226)Ra, (234)U and (238)U varies between 0.8 and 21.2 µSv/y so the consumption of these waters does not involve any risks to population due to its natural radioactivity content.

Caracterización del consumo de suplementos nutricionales en población físicamente activa de gimnasios del sur de Chile / Characterization of nutritional supplements consumption in physically active population in gyms of southern Chile

El consumo de suplementos nutricionales (SN) se ha investigado generalmente en relación al rendimiento deportivo. Menos información existe en relación a población no deportista pero físicamente activa. Objetivo y metodología: El objetivo fue conocer las características de los consumidores de SN en 412 usuarios (179 mujeres) de gimnasios de cuatro ciudades del sur de Chile. El instrumento utilizado para recolectar datos correspondió a un cuestionario previamente validado (1), estructurado con preguntas cerradas, alternativas y preguntas abiertas en relación al consumo de SN. Para su interpretación se utilizaron estadísticos descriptivos y de comparación (i.e. Chi cuadrado). El nivel de significancia estadística se estableció en p<0,05. Resultados: los resultados revelan que 22% de los usuarios consumen SN. De los hombres consumidores, 37% lo realiza para aumentar masa muscular y 36% para mejorar el rendimiento físico. Entre las mujeres, 32% los consume por motivos relacionados a salud. Los SN más consumidos fueron: proteínas (36%), vitaminas y minerales (11%), creatina (10%), aminoácidos y carbohidratos (8%). En cuanto al perfil del consumidor, está representado por jóvenes de entre 15 a 25 años, dedicados en su mayoría al estudio y al trabajo, con menos de un año de asistencia al gimnasio y una frecuencia de asistencia ≥ 3 sesiones/semana. Conclusión: un relativamente bajo consumo de SN fue observado,en comparación con deportistas, influenciado por la edad,el género y el uso de dieta o alimentación especial. Varones jóvenes (i.e. 15 a 25 años de edad) que trabajan, con una alta frecuencia de asistencia a gimnasios (≥ 3 sesiones/semana) son los principales consumidores de SN...

Utilization of molasses and sugar cane bagasse for production of fungal invertase in solid state fermentation using Aspergillus niger GH1.

Agro-industrial wastes have been used as substrate-support in solid state fermentation for enzyme production. Molasses and sugarcane bagasse are by-products of sugar industry and can be employed as substrates for invertase production. Invertase is an important enzyme for sweeteners development. In this study, a xerophilic fungus Aspergillus niger GH1 isolated of the Mexican semi-desert, previously reported as an invertase over-producer strain was used. Molasses from Mexico and Cuba were chemically analyzed (total and reducer sugars, nitrogen and phosphorous contents); the last one was selected based on chemical composition. Fermentations were performed using virgin and hydrolyzate bagasse (treatment with concentrated sulfuric acid). Results indicated that, the enzymatic yield (5231 U/L) is higher than those reported by other A. niger strains under solid state fermentation, using hydrolyzate bagasse. The acid hydrolysis promotes availability of fermentable sugars. In addition, maximum invertase activity was detected at 24 h using low substrate concentration, which may reduce production costs. This study presents an alternative method for invertase production using a xerophilic fungus isolated from Mexican semi-desert and inexpensive substrates (molasses and sugarcane bagasse).

Utilization of molasses and sugar cane bagasse for production of fungal invertase in solid state fermentation using Aspergillus niger GH1

Agro-industrial wastes have been used as substrate-support in solid state fermentation for enzyme production. Molasses and sugarcane bagasse are by-products of sugar industry and can be employed as substrates for invertase production. Invertase is an important enzyme for sweeteners development. In this study, a xerophilic fungus Aspergillus niger GH1 isolated of the Mexican semi-desert, previously reported as an invertase over-producer strain was used. Molasses from Mexico and Cuba were chemically analyzed (total and reducer sugars, nitrogen and phosphorous contents); the last one was selected based on chemical composition. Fermentations were performed using virgin and hydrolyzate bagasse (treatment with concentrated sulfuric acid). Results indicated that, the enzymatic yield (5231 U/L) is higher than those reported by other A. niger strains under solid state fermentation, using hydrolyzate bagasse. The acid hydrolysis promotes availability of fermentable sugars. In addition, maximum invertase activity was detected at 24 h using low substrate concentration, which may reduce production costs. This study presents an alternative method for invertase production using a xerophilic fungus isolated from Mexican semi-desert and inexpensive substrates (molasses and sugarcane bagasse).

Uranium and thorium sequential separation from norm samples by using a SIA system.

This study presents a sequential radiochemical separation method for uranium and thorium isotopes using a novel Sequential Injection Analysis (SIA) system with an extraction chromatographic resin (UTEVA). After the separation, uranium and thorium isotopes have been quantified by using alpha-particle spectrometry. The developed method has been tested by analyzing an intercomparison sample (phosphogypsum sample) from International Atomic Energy Agency (IAEA) with better recoveries for uranium and thorium than the obtained by using a classical method (93% for uranium using the new methodology and 82% with the classical method, and in the case of thorium the recoveries were 70% for the semi-automated method and 60% for the classical strategy). Afterwards, the method was successfully applied to different Naturally Occurring Radioactive Material (NORM) samples, in particular sludge samples taken from a drinking water treatment plant (DWTP) and also sediment samples taken from an area of influence of the dicalcium phosphate (DCP) factory located close to the Ebro river reservoir in Flix (Catalonia). The obtained results have also been compared with the obtained by the classical method and from that comparison it has been demonstrated that the presented strategy is a good alternative to existing methods offering some advantages as minimization of sample handling, reduction of solvents volume and also an important reduction of the time per analysis.

Comparative study of different analytical methods for the determination of 238U, 234U, 235U, 230Th and 232Th in NORM samples (Southern Catalonia).

Uranium and thorium isotopes from sludge samples taken from an area of influence of a dicalcium phosphate factory, located close to the Ebro River reservoir in Flix, and from mineral raw materials (coal and phosphate) which were deposited in Tarragona Harbour (Catalonia) have been measured. To do that, several procedures to determine these isotopes have been applied and compared in terms of accuracy, precision and total analysis time. In particular, digestion procedures, such as one based on conventional acidic digestion or another based on the use of microwave digestion, have been tested. Moreover, different radiochemical separation procedures have been applied. In this regard, one method based on liquid-liquid extraction using TBP/Xylene and another based on the use of extraction chromatography using UTEVA resins have been compared. Firstly, the different proposed methods were tested by analyzing a phosphogypsum sediment and a moss-soil sample from two different intercomparison exercises. The microwave digestion - UTEVA method provided the best results (recoveries higher than 82% for uranium and thorium isotopes) and was then applied to the NORM samples. The obtained results showed that the higher uranium and thorium activities values were found in phosphate raw material and in the more superficial samples located in sludge sediments next to the dicalcium phosphate factory.

Safety of two cluster schedules for subcutaneous immunotherapy in allergic rhinitis or asthma patients sensitized to inhalant allergens.

BACKGROUND: Subcutaneous immunotherapy (SCIT) usually requires a long titration phase, which can be associated with various adverse events (AEs). OBJECTIVES: It was the aim of this study to determine the safety of 2 cluster regimens for SCIT in patients with allergic rhinitis, with or without mild or moderate allergic asthma, who were sensitized to grass and/or tree pollen, or house dust mites (HDM). PATIENTS AND METHODS: Adult patients were included in a European, open-label, prospective trial. Pollen-allergic patients received grass pollen, grass and olive pollen, or hazel, alder and birch pollen according to a 3-week titration cluster. HDM-allergic patients received HDM extract according to a 2-week titration cluster. The safety of the titration phase was assessed in terms of local and systemic AEs. RESULTS: The safety analysis included 157 patients: 110 received pollen and 47 HDM extract. During the cluster titration, 248 AE episodes were reported in the pollen group and 113 in the HDM group; these were mainly local reactions. Around one third of patients (30.9% pollen and 38.3% HDM) did not experience any AE. In most cases (67.1% of pollen and 71.1% of HDM patients), AEs did not lead to a change in titration schedule. No anaphylactic reaction or other serious life-threatening systemic AEs were reported. Only 2 patients in the HDM group discontinued treatment because of AEs. CONCLUSIONS: Rapid cluster titration was well tolerated in adults with allergic rhinitis, with or without mild to moderate allergic asthma, due to pollen or HDM. This short-titration, high-dose cluster regime may allow better patient compliance and cost savings.

Improving pollen immunotherapy: minor allergens and panallergens.

Multiple sensitizations to pollens are common clinical situations in Spain, and alter the efficacy of allergen-specific immunotherapy. We now know that optimization of the diagnosis is required to define the best suited treatment for each patient. All pollen allergens belong to 29 families of proteins - the most abundant being the expansins, prophyllins and polcalcins. The ubiquitous nature of proteins such as the prophyllins and polcalcins defines them as panallergens, and explains the cross-reactivity that is erroneously interpreted by clinicians as constituting multi-sensitization. Other families of allergens, such as the calcium transporting proteins (LTPs) are more restricted, but are associated to severe types of allergic disease - this being particularly useful to decide upon the indication of immunotherapy. Although recombinant allergens can be produced for in vitro diagnostic purposes, current legislation only allows the use of natural proteins for immunotherapy. However, the same technology can be applied to the study of extracts for vaccines, and it seems that allergen quantification by the manufacturers is a no return trip which clinicians are obliged to follow.

Improving pollen immunotherapy: minor allergens and panallergens

Multiple sensitizations to pollens are common clinical situations in Spain, and alter the efficacy of allergen-specific immunotherapy. We now know that optimization of the diagnosis is required to define the best suited treatment for each patient. All pollen allergens belong to 29 families of proteins ­ the most abundant being the expansins, prophyllins and polcalcins. The ubiquitous nature of proteins such as the prophyllins and polcalcins defines them as panallergens, and explains the cross-reactivity that is erroneously interpreted by clinicians as constituting multi-sensitization. Other families of allergens, such as the calcium transporting proteins (LTPs) are more restricted, but are associated to severe types of allergic disease ­ this being particularly useful to decide upon the indication of immunotherapy. Although recombinant allergens can be produced for in vitro diagnostic purposes, current legislation only allows the use of natural proteins for immunotherapy. However, the same technology can be applied to the study of extracts for vaccines, and it seems that allergen quantification by the manufacturers is a no return trip which clinicians are obliged to follow

No disponible

Efeitos dos programas de luz sobre desempenho, rendimento de carcaça e resposta imunológica em frangos de corte / Effect of lighting programs on performance, carcass yield, and immunological response of broiler chickens

Avaliaram-se os efeitos dos programas de luz 23L:1E (23L); crescente (CRES); 16L:8E (16L) e luz natural (NAT) sobre o desempenho, rendimento de carcaça e resposta imunológica de frangos de corte machos da linhagem Cobb-500. O período de criação foi de um a 45 dias de idade, e os tratamentos foram definidos de acordo com os programas de luz. O delineamento experimental foi o inteiramente ao acaso com quatro tratamentos e seis repetições de 35 aves cada. As aves submetidas ao programa de luz CRES apresentaram maior peso vivo em relação aos demais tratamentos (P<0,05). O consumo de ração também foi maior para as aves do tratamento CRES quando comparado aos tratamentos 23L e NAT (P<0,05), e semelhante ao tratamento 16L (P>0,05). A viabilidade das aves do tratamento NAT foi maior em relação às aves do tratamento 23L (P<0,05) e semelhante aos demais tratamentos (P>0,05). A conversão alimentar e o rendimento de carcaça não foram influenciados pelos tratamentos (P>0,05). As aves do tratamento 23L apresentaram maior rendimento de peito quando comparado aos demais tratamentos (P<0,05). A produção de anticorpos para a doença de Newcastle não foi afetada pelos tratamentos (P>0,05).

The effects of lighting programs 23L:1E (23L); increasing (INC); 16L: 8E (16L) and natural light (NAT) on performance, carcass yield and immune response of Cobb-500 male broiler were evaluated. Chicks were raised from one to 45-day-old and the treatments were defined according to the lighting programs. The experiment was designed in four treatments with six repetitions of 35 birds each. Broilers of the INC lighting program showed heavier weights (P<0.05). Feed consumption was higher in broilers of the INC treatment when compared to the 23L and NAT (P<0.05), and similar to the 16L (P>0.05). The viability of the NAT treatment broilers was higher than the broilers of the 23L (P<0.05) and similar to the other treatments. Feed conversion and carcass yield were not influence by the treatments (P>0.05). The 23L treatment broilers showed higher breast yield when compared to the other treatments (P<0.05). Differences were not observed among the treatments regarding antibodies levels against Newcastle disease (P>0.05).

Mejorando la inmunoterapia con pólenes: alergenos minoritarios y panalergenos / No disponible

La sensibilización múltiple a pólenes es una situación clínica frecuente en España que condiciona la eficacia de la inmunoterapia alérgeno-específica. Hoy sabemos que se necesita optimizar el diagnóstico para seleccionar el tratamiento adecuado para cada paciente. Abordar la alergología a nivel molecular aparentemente complica el manejo asistencial y sin embargo, basta cruzar los registros de una base de datos de familias de proteínas secuenciadas1 con los de otra de alergenos conocidos , para obtener un número limitado de proteínas alergénicas que a su vez pueden ser clasificadas por su origen taxonómico3. La información final puede consultarse de forma integrada en otra base de datos4 que actualiza ágilmente lo referente a características bioquímicas, origen, función biológica, documentación clínica y disponibilidad industrial de alergenos. Todos los alergenos polínicos pertenecen a 29 familias de proteínas, siendo las más abundantes las expansinas, profilinas y polcalcinas. La naturaleza ubicua de proteínas como las profilinas y polcalcinas les confieren carácter de panalergenos y explica la reactividad cruzada, que es interpretada erróneamente por los clínicos como multisensibilidad. Otras familias de alergenos, como las proteínas transportadoras de calcio (LTPs), son más restringidas pero se asocian a un perfil de especial gravedad clínica, lo que resulta especialmente útil a la hora de indicar la inmunoterapia. El diagnóstico más preciso lo dan las proteínas muy selectivas de especie, como las expansinas de las gramíneas. Aunque es posible la fabricación de alergenos recombinantes para el diagnóstico in vitro, la legislación actual sólo permite el uso de proteínas naturales para inmunoterapia. Sin embargo, es posible aplicar la misma tecnología al estudio de los extractos para vacunas, y parece que la cuantificación de alergenos por parte de los fabricantes es un camino sin retroceso que los clínicos estamos obligados a seguir (AU)

No disponible

[Immunotherapy with an oral Alternaria extract in childhood asthma. Clinical safety and efficacy and effects on in vivo and in vitro parameters]. / Inmunoterapia con un extracto oral de Alternaria en el asma infantil. Eficacia clínica, seguridad, repercusiones sobre parámetros in vivo e in vitro.

Studies of immunotherapy with oral Alternaria extracts are scarce. We decided to perform a clinical trial of the clinical safety and efficacy of this extract as well as of its effects on in vivo and in vitro parameters in 39 patients with Alternaria allergy, aged between 7 and 17 years, who are also sensitized extract was used. Allergic activity was determined through RAST inhibition and skin prick test. Quantification of the principal allerten (Alt a 1) was performed through the 2-site binding assay, with a mean content of 34.2 ng Alt a 1/micro g protein. The parameters analyzed were the symptom-medication score, skin prick using the end-point technique, specific bronchial challenge test, peak flow, total and specific IgE and IgG4. Nineteen patiens received active treatment with oral immunotherapy and another 19 received symptomatic treatment. The initial phase of immunotherapy lasted 3 months until the maximum dose was reached. This was maintained for 12 months; the mean accumulated dos was 280,000 PNU. Significant differences were found in reduction in the symptom-medication score in the treated group after 12 months of immunotherapy. No differences were found in the control group. Immunotherapy was well tolerated with 0.42 adverse reactions per 100 doses administered. All adverse reactions were mild-to-moderate. In the treated group, papule size was significantly reduced. Values for the specific bronchial challenge test, expressed through PD20, were significantly higher in the immunotherapy group. Peak flow showed no changes in either group. Values of IgG4 were significantly higher in the immunotherapy group. Total and specific IgE levels showed no significant changes in either group. In conclusion, oral immunotherapy with Alternaria extract is clinically effective in pediatric patients. In general, the therapy was well tolerated. It modified specific cutaneous and bronchial reactivity in our sample and increased levels of specific IgG4, wich are implicated in humoral response.

Inmunoterapia con un extracto oral del Alternaria en el asma infantil. Eficacia clínica, seguridad, repercusines sobre parámetros in vivo e in vitro / Immunotherapy with an oral Alternaria extract in chilhood asthma. Clinical safety and efficacy and effects on in vivo and in vitro

Ante la escasez de trabajos con inmunoterapia oral de Alternaria, planteamos la realización de un ensayo clínico en 39 pacientes, con edades comprendidas entre 7 y 17 años, alérgicos a Alternaria, y sensibilizados también a pólenes y epitelios para evaluar su eficacia clínica y seguridad, así como las repercusiones sobre parámetros in vivo e in vitro. Se empleó un extracto estandarizado, determinando la actividad alérgica mediante RAST inhibición y prick test cutáneo. La cuantificación del alergeno principal (Alt a 1) se llevó a cabo mediante la técnica de fijación en dos lugares, siendo el contenido medio de 34,2 ng Alt a 1/ g de proteína. Los parámetros analizados fueron la puntuación de síntomas-medicación, prick test cutáneo a punto final (TC), test de bronco provocación específico (TBPE), pico de flujo (PF), IgE total y específica e IgG4.Diecinueve pacientes recibieron tratamiento activo con inmunoterapia oral (ITO) y otros diecinueve recibieron tratamiento sintomático. La fase de inicio de la inmunoterapia duró 3 meses, hasta llegar a dosis máxima, que se mantuvo durante 12 meses, alcanzando una dosis acumulada media de 280.000 PNU. Se hallaron diferencias significativas en la disminución de la puntuación de síntomas-medicación en el grupo tratado, tras los 12 meses de inmunoterapia (ITO). No se encontraron diferencias en el grupo control. La inmunoterapia fue bien tolerada, presentando 0,42 reacciones adversas (RA) por 100 dosis administradas, siendo de carácter leve-moderado exclusivamente. Se encontró disminución significativa del tamaño de pápula en el grupo tratado. El TBPE expresado mediante la PD20 mostró cifras significativamente más altas en el grupo con ITO. El pico de flujo no mostró cambios en ninguno de los dos grupos. Los valores de la IgG4 fueron significativamente más altos en el grupo con inmunoterapia. Los niveles de IgE total y específica no mostraron cambios significativos en ambos grupos. En conclusión, la Inmunoterapia Oral con extracto de Alternaria ha demostrado eficacia clínica en pacientes pediátricos, siendo en general bien tolerada, modificando la reactividad específica cutánea y bronquial con incremento de los niveles de IgG4 específica implicados en la respuesta humoral (AU)

Studies of immunotherapy with oral Alternaria extracts are scarce. We decided to perform a clinical trial of the clinical safety and efficacy of this extract as well as of its effects on in vivo and in vitro parameters in 39 patients with Alternaria allergy, aged between 7 and 17 years, who are also sensitized extract was used. Allergic activity was determined through RAST inhibition and skin prick test. Quantification of the principal allerten (Alt a 1) was performed through the 2-site binding assay, with a mean content of 34.2 ng Alt a 1/μg protein. The parameters analyzed were the symptom-medication score, skin prick using the end-point technique, specific bronchial challenge test, peak flow, total and specific IgE and IgG4. Nineteen patiens received active treatment with oral immunotherapy and another 19 received symptomatic treatment. The initial phase of immunotherapy lasted 3 months until the maximum dose was reached. This was maintained for 12 months; the mean accumulated dos was 280,000 PNU. Significant differences were found in reduction in the symptom-medication score in the treated group after 12 months of immunotherapy. No differences were found in the control group. Immunotherapy was well tolerated with 0.42 adverse reactions per 100 doses administered. All adverse reactions were mild-to-moderate. In the treated group, papule size was significantly reduced. Values for the specific bronchial challenge test, expressed through PD20, were significantly higher in the immunotherapy group. Peak flow showed no changes in either group. Values of IgG4 were significantly higher in the immunotherapy group. Total and specific IgE levels showed no significant changes in either group. In conclusion, oral immunotherapy with Alternaria extract is clinically effective in pediatric patients. In general, the therapy was well tolerated. It modified specific cutaneous and bronchial reactivity in our sample and increased levels of specific IgG4, wich are implicated in humoral response (AU)

Thalamic distribution of zinc-rich terminal fields and neurons of origin in the rat.

Several cortico-cortical and limbic-related circuits are enriched in zinc, which is considered as an important modulator of glutamatergic transmission. While heavy metals have been detected in the thalamus, the specific presence of zinc has not been examined in this region. We have used two highly sensitive variations of the Timm method to study the zinc-rich innervation in the rat thalamus, which was compared to the distribution of acetylcholinesterase activity. The origin of some of these zinc-rich projections was also investigated by means of retrograde transport after intracerebral infusions of sodium selenium (Na2SeO3). The overall zinc staining in the thalamus was much lower than in the neocortex, striatum or basal forebrain; however, densely stained terminal fields were observed in the dorsal tip of the reticular thalamic nucleus, the anterodorsal and lateral dorsal thalamic nuclei and the zona incerta. In addition, moderately stained zinc-rich terminal fields were found in the rostral intralaminar nuclei, nucleus reuniens and lateral habenula. Intracerebral infusions of Na2SeO3 in the lateral dorsal nucleus resulted in retrogradely labeled neurons that were located in the postsubiculum, and also in the pre- and parasubiculum. These results are the first to establish the existence of a zinc-rich subicular-thalamic projection. Similar infusions in either the intralaminar nuclei or the zona incerta resulted in labeling of neurons in several brainstem structures related to the reticular formation. Our results provide morphological evidence for zinc modulation of glutamatergic inputs to highly selective thalamic nuclei, arising differentially from either cortical limbic areas or from brainstem ascending activation systems.

Management of indigenous plant-microbe symbioses aids restoration of desertified ecosystems.

Disturbance of natural plant communities is the first visible indication of a desertification process, but damage to physical, chemical, and biological soil properties is known to occur simultaneously. Such soil degradation limits reestablishment of the natural plant cover. In particular, desertification causes disturbance of plant-microbe symbioses which are a critical ecological factor in helping further plant growth in degraded ecosystems. Here we demonstrate, in two long-term experiments in a desertified Mediterranean ecosystem, that inoculation with indigenous arbuscular mycorrhizal fungi and with rhizobial nitrogen-fixing bacteria not only enhanced the establishment of key plant species but also increased soil fertility and quality. The dual symbiosis increased the soil nitrogen (N) content, organic matter, and hydrostable soil aggregates and enhanced N transfer from N-fixing to nonfixing species associated within the natural succession. We conclude that the introduction of target indigenous species of plants associated with a managed community of microbial symbionts is a successful biotechnological tool to aid the recovery of desertified ecosystems.

Efficacy of newer medications for treating depression in primary care patients.

PURPOSE: Several medications have recently been introduced for the treatment of depression. We reviewed the literature to summarize their efficacy in the treatment of depression in adult patients in primary care settings. METHODS: We searched the literature published from 1980 to January 1998 using the Cochrane Collaboration Depression Anxiety and Neurosis Group's specialized registry of 8,451 clinical trials, references from trials and 46 pertinent meta-analyses, and consultation with experts. We included randomized controlled trials of at least 6 weeks' duration that measured clinical outcomes and compared one of 32 newer medications with another newer antidepressant, an older antidepressant, a placebo, or a psychosocial intervention for the treatment of depressed patients in primary care settings. The primary outcome was response rate, defined as the proportion of patients experiencing a 50% or greater improvement in depressive symptoms. RESULTS: There were 28 randomized controlled trials involving 5,940 adult primary care patients with major depression, depression requiring treatment, dysthymia, or mixed anxiety depression. Newer agents, including selective serotonin re-uptake inhibitors, serotonin norepinephrine inhibitors, reversible inhibitors of monoamine oxidase, and dopamine antagonists, were usually compared with tricyclic agents. Average response rates were 63% for newer agents, 35% for placebo, and 60% for tricyclic agents. Newer agents were significantly more effective than placebo [risk ratio = 1.6; 95% confidence interval (CI), 1.2 to 2.1), but similar to tricyclic agents (risk ratio = 1.0; 95% CI, 0.9 to 1.1). Response rates were similar in the different types of depressive disorders, except that two small trials in frail older patients showed no significant effects of newer agents compared with placebo. Dropout rates as a result of adverse effects were 8% with newer agents and 13% with tricyclic agents (P <0.05). CONCLUSIONS: In primary care settings, newer antidepressants are more effective than placebo and have similar efficacy compared with tricyclic agents in the acute treatment of depression. Dropout rates as a result of adverse effects are lower with newer compared with tricyclic agents. Future studies should compare the effectiveness of different therapies among primary care patients with less severe depression and greater medical and psychiatric comorbidity.

A systematic review of newer pharmacotherapies for depression in adults: evidence report summary.

BACKGROUND: Depressive disorders are persistent, recurring illnesses that cause great suffering for patients and their families. PURPOSE: To evaluate the benefits and adverse effects of newer pharmacotherapies and herbal treatments for depressive disorders in adults and adolescents. DATA SOURCES: English-language and non-English-language literature from 1980 to January 1998 was identified from a specialized registry of controlled trials, meta-analyses, and experts. STUDY SELECTION: Randomized trials evaluating newer antidepressants (such as serotonin reuptake inhibitors, serotonin norepinephrine reuptake inhibitors, and St. John's wort) that reported clinical outcomes were selected. DATA EXTRACTION: Two persons independently abstracted data that were then synthesized descriptively; some data were pooled by using a random-effects model. DATA SYNTHESIS: Of 315 eligible trials, most evaluated antidepressants in adults with major depression, were conducted among outpatients, and examined acute-phase treatment. Newer antidepressants were more effective than placebo for major depression (relative benefit, 1.6 [95% CI, 1.5 to 1.7]) and dysthymia (relative benefit, 1.7 [CI, 1.3 to 2.3]). They were effective among older adults and primary care patients. Efficacy did not differ among newer agents or between newer and older agents. Hypericum (St. John's wort) was more effective than placebo for mild to moderate depression (risk ratio, 1.9 [CI, 1.2 to 2.8]), but publication bias may have inflated the estimate of benefit. Newer and older antidepressants did not differ for overall discontinuation rates, but side effect profiles varied significantly. Data were insufficient for determining the efficacy of newer antidepressants for subsyndromal depression, depression with coexisting medical or psychiatric illness, or depression in adolescents. CONCLUSIONS: Newer antidepressants are clearly effective in treating depressive disorders in diverse settings. Because of similar efficacy, both newer and older antidepressants should be considered when making treatment decisions. Better information is urgently needed on the efficacy of newer antidepressants in patients with nonmajor depression and in special populations, including adolescents.