Online citations, reference lists, and bibliographies.
← Back to Search

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

Save to my Library
Download PDF
Analyze on Scholarcy Visualize in Litmaps
Share
Reduce the time it takes to create your bibliography by a factor of 10 by using the world’s favourite reference manager
Time to take this seriously.
Get Citationsy
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
10.1016/0163-8343(92)90094-Q
Epidemiology of depression in primary care.
W. Katon (1992)
10.1136/bmj.306.6879.683
Selective serotonin reuptake inhibitors: meta-analysis of efficacy and acceptability.
F. Song (1993)
10.1001/JAMA.1995.03520370068039
Collaborative management to achieve treatment guidelines. Impact on depression in primary care.
W. Katon (1995)
10.1136/bmj.310.6992.1433
Treatment discontinuation with selective serotonin reuptake inhibitors compared with tricyclic antidepressants: a meta-analysis
I. Anderson (1995)
10.1136/BMJ.313.7061.829
Prescribing antidepressants in general practice
T. Kendrick (1996)
10.1136/BMJ.314.7083.826
Prescribing antidepressants in general practice. Systematic review of all pertinent trials is required to establish guidelines.
D. Gill (1997)
10.1192/BJP.170.2.120
Discontinuation rates of SSRIs and tricyclic antidepressants: a meta-analysis and investigation of heterogeneity.
M. Hotopf (1997)
10.1192/BJP.171.5.427
Outcome of anxiety and depressive disorders in primary care.
C. Ronalds (1997)
10.1002/(SICI)1520-6394(1997)6:1<10::AID-DA2>3.0.CO;2-9
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
(1998)
10.1097/00001504-199901000-00026
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)
10.7326/0003-4819-132-9-200005020-00011
A Systematic Review of Newer Pharmacotherapies for Depression in Adults: Evidence Report Summary: Clinical Guideline, Part 2
J. Williams (2000)
10.1136/bmj.325.7371.991
Meta-analysis of effects and side effects of low dosage tricyclic antidepressants in depression: systematic review
T. Furukawa (2002)



This paper is referenced by
10.1007/s11096-020-01223-w
Prescribing patterns of psychotropic medications in psychiatric disorders: a descriptive study from Palestine
S. Hattab (2021)
10.5498/wjp.v11.i7.316
Selective serotonin reuptake inhibitors and risk reduction for cardiovascular disease in patients with schizophrenia: A controversial but promising approach
A. Bellon (2021)
10.1002/mpr.1820
A mindful yoga intervention for young women with major depressive disorder: Design and baseline sample characteristics of a randomized controlled trial
N. Vollbehr (2020)
10.1007/s00210-020-01838-w
Impact of some oral hypoglycemic agents on type 2 diabetes-associated depression and reserpine-induced depression in rats: the role of brain oxidative stress and inflammation
E. Soliman (2020)
10.1007/978-3-030-30687-8_13
Psychopharmacology of Anxiety Disorders
Andrew Melaragno (2020)
10.1186/s12888-020-02519-x
Spatio-temporal dynamics of EEG features during sleep in major depressive disorder after treatment with escitalopram: a pilot study
L. Wu (2020)
10.20944/preprints202010.0163.v1
SSRIs as Risk Reduction for Cardiovascular Disease in Patients with Schizophrenia
A. Bellon (2020)
10.1007/s11938-020-00316-9
Who Needs Gastroprotection in 2020?
Takeshi Kanno (2020)
10.1186/s12888-020-02749-z
Trends in psychiatric diagnoses, medications and psychological therapies in a large Swedish region: a population-based study
T. Forslund (2020)
10.1080/19932820.2020.1725991
Antidepressant effect of Gentiana olivieri Griseb. in male rats exposed to chronic mild stress
Ahmet Berk (2020)
10.1111/apt.15507
Risks of hospitalization for upper gastrointestinal bleeding in users of selective serotonin reuptake inhibitors after Helicobacter pylori eradication therapy: a propensity score matching analysis
Chuan-Guo Guo (2019)
10.1016/J.HLC.2019.07.011
SSRI/SNRI Therapy is Associated With a Higher Risk of Gastrointestinal Bleeding in LVAD Patients.
George Mawardi (2019)
10.1007/s12445-019-0364-8
Antidepressiva in de dagelijkse praktijk
Laura de Wit (2019)
10.1002/14651858.CD012347.PUB2
Psychological therapies for the treatment of depression in chronic obstructive pulmonary disease.
Justyna Pollok (2019)
10.3389/fpsyt.2019.00730
Treatment of Resistant Depression: A Pilot Study Assessing the Efficacy of a tDCS-Mindfulness Program Compared With a tDCS-Relaxation Program
Aurore Monnart (2019)
10.17340/JKNA.2019.2.6
Prescription Pattern of Antidepressants in Korea for Major Neurological Disorders: Before the Policy Change in 2017
Yoonah Park (2019)
10.1371/journal.pone.0222791
The epidemiology of antidepressant use in South Korea: Does short-term antidepressant use affect the relapse and recurrence of depressive episodes?
M. Kim (2019)
RISKS OF HOSPITALIZATION FOR UPPER GASTROINTESTINAL BLEEDING IN SELECTIVE SEROTONIN REUPTAKE INHIBITORS USERS AFTER HELICOBACTER PYLORI ERADICATION THERAPY: A PROPENSITY SCORE MATCHING ANALYSIS Running title: UGIB risk of SSRI
Chuan-Guo Guo (2019)
10.1097/PSY.0000000000000678
Major Depressive Disorder in Medical Illness: A Review of Assessment, Prevalence, and Treatment Options
R. Thom (2019)
10.23736/S0031-0808.18.03518-8
Role in depression of a multi-fractionated versus a conventional Hypericum perforatum extract.
F. Di Pierro (2018)
10.1371/journal.pone.0207921
Psychotropic use patterns: Are there differences between men and women?
Camila Stéfani Estancial Fernandes (2018)
10.1016/j.sapharm.2018.11.009
Depression treatment use among stroke individuals with depression: A cross-sectional analysis of the Medical Expenditure Panel Survey.
Raj Desai (2018)
10.1007/s11065-018-9369-5
A meta-analysis of the effects of antidepressants on cognitive functioning in depressed and non-depressed samples
C. E. Prado (2018)
Assessment of health-related quality of life , patient-reported mental health status and psychological distress based on the type of pharmacotherapy used among patients with depression
D. Shah (2018)
10.1007/s11901-018-0386-x
Clinical Impact of Depression in Cirrhosis
J. Serigado (2018)
Study of Adherence Pattern of Antidepressants in Patients with Depression.
J. Shrestha Manandhar (2017)
Chapter 2 Psychological Issues in Adults with Type 2 Diabetes
Jeffrey S Gonzalez (2017)
10.1016/B978-0-12-811140-6.00003-5
Chapter 3 – Major Depressive Disorder
A. Malik (2017)
10.1192/pb.bp.116.054270
Are men under-treated and women over-treated with antidepressants? Findings from a cross-sectional survey in Sweden
Lena Thunander Sundbom (2017)
10.25149/1756-8358.1301009
Efficacy of GLOW™ on Alleviating Symptoms of Inattention, Hyperactivity/Impulsivity, Depression and Sexual Dysfunction; A Preliminary Study
M. Castellanos (2017)
The influence of gender and depression on drug utilization : Pharmacoepidemiological research in Sweden
L. T. Sundbom (2017)
10.1007/978-3-319-29294-6_6
Cognitive Behavioral Therapy for Adherence and Depression in Diabetes
Jeffrey S Gonzalez (2017)
See more
Semantic Scholar Logo Some data provided by SemanticScholar