Clinical Question: Which of the new...

Clinical Question: Which of the newer antidepressants is safer and more effective?

Setting: Various (meta-analysis)

research Design: Meta-analysis (randomized controlled trials)

Synopsis: The researchers who performed this systematic review and meta-analysis of the safety, tolerability, and effectiveness of the newer antidepressants used six databases to find all randomized controll studies of common antidepressant versus another of at least 12 weeks' duration. They also searched relation lists of review articles; contacted pharmaceutical manufacturers; and tried, unsuccessfully to obtain unpublished data filed with the U fare and Drug Administration. Two researchers independently reviewed the articles for eligibility, and the data were abstracted from the rareed studies by trained reviewers and then evaluated by way of another researcher. The 46 studies, 85 percent of which were sponsored by way of pharmaceutical companies, were of varying quality. The quality of greatest in quantity of the effectiveness studies (21 of 22) was fair, and undivided study was rated as virtuous Twenty of these trials base no difference between the sum of two units antidepressants they evaluated. Two trials fix a difference in at least single in kind outcome: escitalopram (Lexapro) produced improved depression scores versus citalopram (Celexa) in common study but not another, and paroxetine (Paxil) was set to be more effective than fluoxetine (Prozac) in common of eight studies comparing the pair drugs. In the meta-analysis, combining the terminates of six studies found no difference between fluoxetine and paroxetine. In five studies (total of 1190 patients), sertraline (Zoloft) was slightly more effective than fluoxetine (relative benefit = 11; 95% confidence interval [CI], 101 to 120) Venlafaxine (Effexor) also was slightly more effective than fluoxetine in six studies of more than 1300 patients (relative benefit = 112; 95% CI, 102 to 123) Faster storm of action was not identified consistently for any specific mix with drugs Similarly, quality of life was not significantly different with any of the physics The overall incidence of adverse efficiencys and discontinuation rates was similar among the antidepressants, although specific adverse general intents were significantly different. Nausea and vomiting rates were consistently higher for venlafaxine than for other antidepressants. Sexual side weights were less common with bupropion (Wellbutrin) than with sertraline and fluoxetine, and were more universal with paroxetine, sertraline, and mirtazapine (Remeron) Weight gain was not systematically compared yet seemed to be highest in the patients receiving mirtazapine and lowest in those receiving fluoxetine.

Bottom Line: When it originates to the new nontricyclic antidepressants, the medical literature does not provide clear guidance as to which common is more effective, of faster charge safer, or better tolerated. Sexual side drifts are lower with bupropion, and nausea strike one as beings to occur more often with venlafaxine. Other research has shown these recently made known drugs to be no more effective or better tolerated than tricyclic antidepressants. For now, patients should be started upon an antidepressant with the realization that greatest in quantity patients will need to switch to another remedy at least once. (Level of Evidence: 1a)

ALLEN F SHAUGHNESSY, PHARM.D.

consideration Reference: Hansen RA, et al. Efficacy and safety of second-generation antidepressants in the treatment of major depressive disorder. Ann Intern M September 20 2005;143:415-26

Used with permission from Shaughnessy AF. No difference among recently made known antidepressants. Accessed online October 20 2005 at: http://www.InfoPOEMs.com.

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