Meta-analytical studies on
new antidepressants

by
Anderson IM. Neuroscience and Psychiatry Unit,
School of Psychiatry and Behavioural Sciences,
University of Manchester, UK.
Br Med Bull 2001;57:161-78


ABSTRACT

A systematic search found 108 meta-analyses of the use of antidepressants in depressive disorders. Defining newer antidepressants as those introduced since the early 1980s, 18 meta-analyses were selected as being informative about their relative efficacy and tolerability in comparative randomised controlled studies (RCTs). Findings with higher confidence include: little difference in efficacy between most new and old antidepressants; superior efficacy of serotonin and noradrenaline re-uptake inhibitors (SNRIs) over selective serotonin re-uptake inhibitors (SSRIs); a slower onset of therapeutic action of fluoxetine over other SSRIs; a different side effect profile of SSRIs to TCAs with superior general tolerability of SSRIs over TCAs; poorer tolerability of fluvoxamine than other SSRIs in a within group comparison; no increased the risk of suicidal acts or ideation in fluoxetine compared with TCAs (or placebo) in low-risk patients. Findings with a lower level of confidence include: greater efficacy of TCAs than SSRIs in in-patients; greater efficacy of amitriptyline than SSRIs; better tolerability of moclobemide than TCAs; no demonstrable difference in tolerability between SSRIs and TCAs in the elderly; no better tolerability of fluvoxamine than TCAs; better tolerability of dothiepin (dosulepin) than SSRIs; better tolerability of sertraline and greater frequency of agitation on fluoxetine than other SSRIs in a within group comparison. In general, the meta-analyses were of uneven quality, as were the studies included, which limits the confidence in many of the results. Generalising from mostly short-term randomised controlled studies to clinical practice requires caution.
TCAs
SSRIs
RIMAs
Options
YKP10A
Bupropion
SNAP-7941
Amineptine
Reboxetine
Nefazodone
Mirtazapine
Venlafaxine
21st Century
Antidepressants
Atypical depression
Retarded depression
Antidepressant metabolism
An individualised approach
Antidepressants: how fast?
Serotonergic genes and suicidality
Discriminative stimulus properties of antidepressants


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