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Verapamil ir vs sr irastriparimia - P.T.B.R. vs P.T.B.S.N.S (Pillay and Tindale, 1993) - A.S.K. vs. J.G.K.A. (Pallister-Borgo 2000) - P.H.S., M.A.A..V.S.R.V., P.M.G.C.S.. & G.S.N.W. vs. V.K.G.V.P.V.M.E. (Wohler 2005). The above-mentioned cases do not consider the patient's capacity for decision making and thus not applicable to the present case. The next category for evaluation of a psychotropic drug is in terms of potential side-effects and toxic reactions (see Table 1 in the Supplementary Appendix, available with full text of this article at NEJM.org). A patient with chronic use of the antidepressant may be at risk. In a retrospective population based analysis of patients with major depression (N = 16,867), the most common SSRI-associated major adverse effects were insomnia (1.6%), increased appetite (1.1%), and weight (0.9%). In the meta-analysis on clinical trials reported at CINP (N = 20,741), increased weight was associated with 1.9% SSRI use. Although not statistically significant, these findings suggest a kmart pharmacy generic drug prices moderate risk for weight gain and associated with SSRIs. The risks associated with SSRI antidepressant use may outweigh the potential benefits. Although some of the studies have been small, no included in the meta-analysis found a significant difference on the change in depression severity as assessed with the Montgomery-Asberg Depression Rating Scale score or the Montgomery-Asberg Depression Rating Scale total score (Gervais et al 1997 vs Bero 2003 & 2004). The results for efficacy in meta-analysis of clinical trials reported to CINP (N = 20,741) support a slightly stronger beneficial effect of SSRIs but still indicate that there is considerable room for improvement. These findings could be attributable to a high attrition rate, which would have resulted in missing trials and the use of non-representative samples: pooled efficacy results are 0.79 (95% confidence interval 1.18–1.59) on the Global Improvement in Function scale. The risk of weight gain may be higher for people with comorbid depression. A case–crossover study of patients with a previous episode of major depression (N = 6) compared the SSRI (imipramine) with placebo (Prozac). The mean (±SD) weight change between baseline and endpoint was −28.10 (±17.37) kg (7.0 ± 3.97). The difference in weight change between the SSRI and placebo group (11.50 kg greater gain at endpoint) did not differ significantly from the difference in weight change between the SSRI and fluoxetine group (−2.09 kg greater gain at endpoint), but the difference in weight change between the SSRI and placebo groups in the fluoxetine group was −16.50 kg, similar to the difference between SSRI and placebo groups in the fluoxetine group (−16.95 kg difference in weight gain at endpoint). These findings suggest that for individuals with a history of depression, the risk weight gain on SSRIs remains greater than that of placebo in a first episode of depression. The results this observational study also do not support the use of SSRIs to reduce weight among older adults or those with comorbid depression (Mannuzza et al 2003). A recent controlled study of the combination sertraline and fluoxetine (the SSRI-fluoxetine combination) showed that although antidepressant use in women with a history of depression was reduced, no benefit on depression was seen (Rothwell and Latham 2003). However, these trials lacked appropriate baseline measures to adjust for depression before antidepressant use. More studies of the SSRI–fluoxetine combination are needed that adjust baseline depression measures on SSRIs and compare antidepressant efficacy against placebo with adequate baseline measures for treatment effect. To summarize, patients with chronic depression using SSRIs need a careful evaluation of potential side-effects. Because many individuals with chronic depression take SSRIs, their risks should be assessed to include weight gain, which could potentially increase the risk for depression relapse as shown by previous studies. Additional studies of the SSRI–fluoxetine combination, in combination with standard and alternative treatments, are needed to evaluate the relative risks and benefits, which may be different from other SSRIs.