Efficacy and Safety for the Newer Antidepressants in Adults [Internet]

Excerpt

BackgroundDepression is a varied illness; patients may present with symptoms such as lack of initiative, a sense of meaninglessness, depressive thoughts and/or suicidal behaviour. Problems with sleep, lack of appetite, energy, drive, anxiety and concentration are also common. Our understanding of the neurobiological causes of depression is incomplete. Reduced accessibility of monoaminergic neurotransmitters in the central nervous systems is one possible explanation. Several antidepressant drugs are available. SSRI (selective serotonin re-uptake inhibitors) and other second-generation antidepressants have been increasingly used in recent years. Antidepressants increase the accessibility of serotonin and/or noradrenalin, either by inhibiting the reuptake or inhibiting the decomposition. This does not seem to explain the effect.

MethodsWe have systematically reviewed the literature for effect and safety in head-to-head studies of SSRI and other second-generation antidepressants used in adults with depression. The literature was identified by a systematic search in international electronic databases. We also received literature from the pharmaceutical industry. We assessed and summarised studies that fulfilled our predetermined criteria.

Results23 studies are included in the report. The 23 studies deal with 12 different comparisons out of 66 possible. Nine different antidepressants were compared. The documentation is of low quality for most of the comparisons. We did not find any differences in effect and safety in the head-to-head studies we analyzed with the exception of: Escitalopram was significantly more effective (response and remission rate) than citalopram. Loss to follow up was significantly lower for escitalopram than for citalopram. Citalopram had a significantly lower adverse event rate than venlafaxin. Mirtazapin was significantly more effective (remission rate) than paroxetin. Loss of follow up due to side effects was significantly lower for fluoksetin than for venlafaxin.

ConclusionWe have included 12 different head-to-head comparisons out of 66 possible. Nine different antidepressants were involved in the comparisons. We did not find any significant differences in effect and safety between the antidepressants except for the comparisons escitalopram versus citalopram, citalopram versus venlafaxin and mirtazapin versus paroxetin where we found significant differences for some of the outcomes. The conclusions are based on documentation of medium or low quality.

Keywords: Depressive Disorder; Depression; Antidepressive Agents; Serotonin Uptake Inhibitors.

Copyright ©2007 by The Norwegian Institute of Public Health (NIPH).