Will tricyclic antidepressants make a comeback for depressed Parkinson disease patients?
Bibliographic record
Abstract
Neurologists and psychiatrists were willing to embrace the revolution of the serotonin reuptake inhibitor (SSRI) which in most offices replaced the standard tricyclic antidepressants (TCA) for treatment of depression in patients with Parkinson disease (PD). It is not hard to imagine how such a drastic transition occurred so rapidly, as there was a desire for a more refined and targeted therapy with fewer side effects (such as dry mouth, dry eyes, constipation, and confusion). The switch occurred, however, in the absence of a prospective, randomized, head-to-head comparison between SSRIs and TCAs. Menza et al.1 offer a true evidence-based comparison in this issue of Neurology ®. With depression reported to occur in 40% or more of patients with PD,2,3 this is an important clinical study. The authors presented a simple study design that compared paroxetine CR, nortriptyline, and placebo in a 52-patient randomized trial. The doses were escalated up to three times, based on the clinician’s discretion, up to a top …
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How this classification was reachedexpand
Full frame machine prediction
Teacher imitationNot calibrated prevalence, not ground truth. Human validation pending. The Gemma side is a direct model label for every work in the frame, read from the title-only record. The Codex side is a classifier learned from the 10,348 direct Codex labels and calibrated to design-weighted sample rates; fields without enough sample support carry no Codex call. Candidate is the union of the two sides; consensus is their intersection. These outputs are machine_predicted_unvalidated and are not human labels.
Distilled classifier scores by category (both heads)
| Category | Codex | Gemma |
|---|---|---|
| Metaresearch | 0.002 | 0.019 |
| Meta-epidemiology (narrow) | 0.001 | 0.000 |
| Meta-epidemiology (broad) | 0.001 | 0.001 |
| Bibliometrics | 0.000 | 0.001 |
| Science and technology studies | 0.002 | 0.001 |
| Scholarly communication | 0.002 | 0.003 |
| Open science | 0.001 | 0.000 |
| Research integrity | 0.026 | 0.015 |
| Insufficient payload (model declined to judge) | 0.004 | 0.004 |
Machine scores (provisional)
The two teacher heads of the student model, read on this work. A score orders the frame for review; it never asserts a category, and the validation status ships verbatim with every row.
Baseline scores from an immature model (maturity gate not passed, 7 training rounds). Scores rank; they never assert a category.
score_only:v0-immature-baseline · verbatim from the scoring run: score_only means the number may rank works, and no category label ships from itClassification
machine, unvalidatedMachine predicted; a candidate call from one source (direct Gemma or distilled Codex), not a consensus.
How this classification was reached, model by model and score by score, is at the end of the page under "How this classification was reached".