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Efficacy And Tolerability Of Selective Serotonin Reuptake Inhibitors Compared With Tricyclic Antidepressants In Depression Treated In Primary Care: Systematic Review And Meta-analysis

S. Macgillivray, B. Arroll, S. Hatcher, S. Ogston, I. Reid, F. Sullivan, B. Williams, I. Crombie
Published 2003 · Medicine

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Abstract Objective: To compare the efficacy and tolerability of tricyclic antidepressants with selective serotonin reuptake inhibitors in depression in primary care. Design: Systematic review and meta-analysis of randomised controlled trials. Data sources: Register of the Cochrane Collaboration's depression, anxiety, and neurosis group. Reference lists of initial studies and other relevant review papers. Selected authors and experts. Selection of studies: Studies had to meet minimum requirements on: adequacy of sample size, adequate allocation concealment, clear description of treatment, representative source of subjects, use of diagnostic criteria or clear specification of inclusion criteria, details regarding number and reasons for withdrawal by group, and outcome measures described clearly or use of validated instruments. Main outcome measures: Standardised mean difference of final mean depression scores and relative risk of response when using the clinical global impression score. Relative risk of withdrawing from treatment at any time, and the number withdrawing due to side effects. Results: 11 studies (2951 participants) compared a selective serotonin reuptake inhibitor with a tricyclic antidepressant. Efficacy between selective serotonin reuptake inhibitors and tricyclics did not differ significantly (standardised weighted mean difference, fixed effects 0.07, 95% confidence interval −0.02 to 0.15; z=1.59, P<0.11). Significantly more patients receiving a tricyclic withdrew from treatment (relative risk 0.78, 95% confidence interval 0.68 to 0.90; z=3.37, P<0.0007) and withdrew specifically because of side effects (0.73, 0.60 to 0.88; z=3.24, P<0.001). Most studies included were small and supported by commercial funding. Many studies were of low methodological quality or did not present adequate data for analysis, or both, and were of short duration, typically six to eight weeks. Conclusion: The evidence on the relative efficacy of selective serotonin reuptake inhibitors and tricyclic antidepressants in primary care is sparse and of variable quality. The study setting is likely to be an important factor in assessing the efficacy and tolerability of treatment with antidepressant drugs. What is already known on this topic Previous meta-analyses have included comparatively large numbers of secondary care based studies that indicate no significant differences in efficacy between selective serotonin reuptake inhibitors and tricyclics Previous meta-analyses are conflicting regarding the relative tolerability between selective serotonin reuptake inhibitors and tricyclics, but do suggest a small but significant difference in favour of selective serotonin reuptake inhibitors Such meta-analyses show notable heterogeneity What this study adds Selective serotonin reuptake inhibitors are better tolerated than tricyclics by primary care patients and may be better tolerated by primary care patients than secondary care patients Study setting seems to be important and should be considered before licences are given to specific antidepressants Although there are limited high quality data, available evidence shows that the most commonly prescribed classes of antidepressants in primary care (selective serotonin reuptake inhibitors and tricyclics) are equally effective in the short term for primary care patients, but the literature has many gaps
This paper references
Epidemiology of depression in primary care.
W. Katon (1992)
Selective serotonin reuptake inhibitors: meta-analysis of efficacy and acceptability.
F. Song (1993)
Collaborative management to achieve treatment guidelines. Impact on depression in primary care.
W. Katon (1995)
Treatment discontinuation with selective serotonin reuptake inhibitors compared with tricyclic antidepressants: a meta-analysis
I. Anderson (1995)
Prescribing antidepressants in general practice
T. Kendrick (1996)
Prescribing antidepressants in general practice. Systematic review of all pertinent trials is required to establish guidelines.
D. Gill (1997)
Discontinuation rates of SSRIs and tricyclic antidepressants: a meta-analysis and investigation of heterogeneity.
M. Hotopf (1997)
Outcome of anxiety and depressive disorders in primary care.
C. Ronalds (1997)
Are SSRIs better than TCAs? Comparison of SSRIs and TCAs: A meta‐analysis
David C. Steffens (1997)
Cochrane collaboration handbook
C D Mulrow (1997)
Collabo - rative management to achieve treatment guidelines : the impact of depression in primary care
W Katon (1997)
Evidence Based Guideline Development Project. The choice of antidepressants for depression in primary care: evidence based clinical practice guideline
England North Of (1998)
The choice of antidepressants for depression in primary care: evidence based clinical practice guideline
The management of depression in primary health care
R. Araya (1999)
The management of depression among general medical service providers
T Suh (1999)
The management of depression among general medical service providers 3 Arya R. The management of depression in primary health care
T Suh (1999)
A Systematic Review of Newer Pharmacotherapies for Depression in Adults: Evidence Report Summary: Clinical Guideline, Part 2
J. Williams (2000)
Meta-analysis of effects and side effects of low dosage tricyclic antidepressants in depression: systematic review
T. Furukawa (2002)

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