Abstract
STUDY OBJECTIVE: To determine why, despite 122 randomised controlled trials, there is no consensus about whether the selective serotonin reuptake inhibitors or tricyclic and related antidepressants should be used as first line treatment of depression. DESIGN: Systematic review of all RCTs comparing selective serotonin reuptake inhibitors and tricyclic or heterocyclic antidepressants. MAIN RESULTS: The shortcomings identified in the 122 trials were as follows: (1) there was inadequate description of randomisation, (2) the outcomes used were mainly observer rated measurements of depression, and studies failed to use quality of life measures or perform economic evaluations, (3) doses of tricyclic antidepressants were inadequate, (4) generalisability of studies was poor (including a reliance on secondary care settings and inadequate follow up), and (5) there were statistical shortcomings such as low statistical power, failure to use intention to treat analyses, and the tendency to make multiple comparisons. CONCLUSIONS: Future RCTs should be designed to inform policy makers and address these methodological shortcomings.
Full text
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Selected References
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- Anderson I. M., Tomenson B. M. Treatment discontinuation with selective serotonin reuptake inhibitors compared with tricyclic antidepressants: a meta-analysis. BMJ. 1995 Jun 3;310(6992):1433–1438. doi: 10.1136/bmj.310.6992.1433. [DOI] [PMC free article] [PubMed] [Google Scholar]
- Bergner M., Bobbitt R. A., Carter W. B., Gilson B. S. The Sickness Impact Profile: development and final revision of a health status measure. Med Care. 1981 Aug;19(8):787–805. doi: 10.1097/00005650-198108000-00001. [DOI] [PubMed] [Google Scholar]
- Beuzen J. N., Ravily V. F., Souetre E. J., Thomander L. Impact of fluoxetine on work loss in depression. Int Clin Psychopharmacol. 1993 Winter;8(4):319–321. doi: 10.1097/00004850-199300840-00019. [DOI] [PubMed] [Google Scholar]
- Blacker C. V., Clare A. W. Depressive disorder in primary care. Br J Psychiatry. 1987 Jun;150:737–751. doi: 10.1192/bjp.150.6.737. [DOI] [PubMed] [Google Scholar]
- Cicchetti D. V., Prusoff B. A. Reliability of depression and associated clinical symptoms. Arch Gen Psychiatry. 1983 Sep;40(9):987–990. doi: 10.1001/archpsyc.1983.01790080069009. [DOI] [PubMed] [Google Scholar]
- Fitzpatrick R., Fletcher A., Gore S., Jones D., Spiegelhalter D., Cox D. Quality of life measures in health care. I: Applications and issues in assessment. BMJ. 1992 Oct 31;305(6861):1074–1077. doi: 10.1136/bmj.305.6861.1074. [DOI] [PMC free article] [PubMed] [Google Scholar]
- Fletcher A., Gore S., Jones D., Fitzpatrick R., Spiegelhalter D., Cox D. Quality of life measures in health care. II: Design, analysis, and interpretation. BMJ. 1992 Nov 7;305(6862):1145–1148. doi: 10.1136/bmj.305.6862.1145. [DOI] [PMC free article] [PubMed] [Google Scholar]
- Freemantle N., House A., Song F., Mason J. M., Sheldon T. A. Prescribing selective serotonin reuptake inhibitors as strategy for prevention of suicide. BMJ. 1994 Jul 23;309(6949):249–253. doi: 10.1136/bmj.309.6949.249. [DOI] [PMC free article] [PubMed] [Google Scholar]
- Fudge J. L., Perry P. J., Garvey M. J., Kelly M. W. A comparison of the effect of fluoxetine and trazodone on the cognitive functioning of depressed outpatients. J Affect Disord. 1990 Apr;18(4):275–280. doi: 10.1016/0165-0327(90)90079-n. [DOI] [PubMed] [Google Scholar]
- Greist J. H., Klein M. H., Erdman H. P., Bires J. K., Bass S. M., Machtinger P. E., Kresge D. G. Comparison of computer- and interviewer-administered versions of the Diagnostic Interview Schedule. Hosp Community Psychiatry. 1987 Dec;38(12):1304–1311. doi: 10.1176/ps.38.12.1304. [DOI] [PubMed] [Google Scholar]
- HAMILTON M. A rating scale for depression. J Neurol Neurosurg Psychiatry. 1960 Feb;23:56–62. doi: 10.1136/jnnp.23.1.56. [DOI] [PMC free article] [PubMed] [Google Scholar]
- Hamilton M. Development of a rating scale for primary depressive illness. Br J Soc Clin Psychol. 1967 Dec;6(4):278–296. doi: 10.1111/j.2044-8260.1967.tb00530.x. [DOI] [PubMed] [Google Scholar]
- Hotopf M., Hardy R., Lewis G. Discontinuation rates of SSRIs and tricyclic antidepressants: a meta-analysis and investigation of heterogeneity. Br J Psychiatry. 1997 Feb;170:120–127. doi: 10.1192/bjp.170.2.120. [DOI] [PubMed] [Google Scholar]
- Hotopf M., Lewis G., Normand C. Are SSRIs a cost-effective alternative to tricyclics? Br J Psychiatry. 1996 Apr;168(4):404–409. doi: 10.1192/bjp.168.4.404. [DOI] [PubMed] [Google Scholar]
- Interferon beta-1b in the treatment of multiple sclerosis: final outcome of the randomized controlled trial. The IFNB Multiple Sclerosis Study Group and The University of British Columbia MS/MRI Analysis Group. Neurology. 1995 Jul;45(7):1277–1285. [PubMed] [Google Scholar]
- Johnson D. A. Depression: treatment compliance in general practice. Acta Psychiatr Scand Suppl. 1981;290:447–453. doi: 10.1111/j.1600-0447.1981.tb00751.x. [DOI] [PubMed] [Google Scholar]
- Jönsson B., Bebbington P. E. What price depression? The cost of depression and the cost-effectiveness of pharmacological treatment. Br J Psychiatry. 1994 May;164(5):665–673. doi: 10.1192/bjp.164.5.665. [DOI] [PubMed] [Google Scholar]
- Kasper S., Voll G., Vieira A., Kick H. Response to total sleep deprivation before and during treatment with fluvoxamine or maprotiline in patients with major depression--results of a double-blind study. Pharmacopsychiatry. 1990 May;23(3):135–142. doi: 10.1055/s-2007-1014496. [DOI] [PubMed] [Google Scholar]
- Kristiansen I. S., Eggen A. E., Thelle D. S. Cost effectiveness of incremental programmes for lowering serum cholesterol concentration: is individual intervention worth while? BMJ. 1991 May 11;302(6785):1119–1122. doi: 10.1136/bmj.302.6785.1119. [DOI] [PMC free article] [PubMed] [Google Scholar]
- Kuhs H., Rudolf G. A. A double-blind study of the comparative antidepressant effect of paroxetine and amitriptyline. Acta Psychiatr Scand Suppl. 1989;350:145–146. doi: 10.1111/j.1600-0447.1989.tb07198.x. [DOI] [PubMed] [Google Scholar]
- Le Pen C., Levy E., Ravily V., Beuzen J. N., Meurgey F. The cost of treatment dropout in depression. A cost-benefit analysis of fluoxetine vs. tricyclics. J Affect Disord. 1994 May;31(1):1–18. doi: 10.1016/0165-0327(94)90122-8. [DOI] [PubMed] [Google Scholar]
- Lewis G. Assessing psychiatric disorder with a human interviewer or a computer. J Epidemiol Community Health. 1994 Apr;48(2):207–210. doi: 10.1136/jech.48.2.207. [DOI] [PMC free article] [PubMed] [Google Scholar]
- Lewis G., Pelosi A. J., Araya R., Dunn G. Measuring psychiatric disorder in the community: a standardized assessment for use by lay interviewers. Psychol Med. 1992 May;22(2):465–486. doi: 10.1017/s0033291700030415. [DOI] [PubMed] [Google Scholar]
- Loonen A. J., Peer P. G., Zwanikken G. J. Continuation and maintenance therapy with antidepressive agents. Meta-analysis of research. Pharm Weekbl Sci. 1991 Aug 23;13(4):167–175. doi: 10.1007/BF01957741. [DOI] [PubMed] [Google Scholar]
- Montgomery S. A., Asberg M. A new depression scale designed to be sensitive to change. Br J Psychiatry. 1979 Apr;134:382–389. doi: 10.1192/bjp.134.4.382. [DOI] [PubMed] [Google Scholar]
- Montgomery S. A., Dufour H., Brion S., Gailledreau J., Laqueille X., Ferrey G., Moron P., Parant-Lucena N., Singer L., Danion J. M. The prophylactic efficacy of fluoxetine in unipolar depression. Br J Psychiatry Suppl. 1988 Sep;(3):69–76. [PubMed] [Google Scholar]
- Montgomery S. A., Henry J., McDonald G., Dinan T., Lader M., Hindmarch I., Clare A., Nutt D. Selective serotonin reuptake inhibitors: meta-analysis of discontinuation rates. Int Clin Psychopharmacol. 1994 Spring;9(1):47–53. doi: 10.1097/00004850-199400910-00008. [DOI] [PubMed] [Google Scholar]
- Montgomery S. A., Kasper S. Comparison of compliance between serotonin reuptake inhibitors and tricyclic antidepressants: a meta-analysis. Int Clin Psychopharmacol. 1995 Jan;9 (Suppl 4):33–40. doi: 10.1097/00004850-199501004-00005. [DOI] [PubMed] [Google Scholar]
- Paykel E. S., Priest R. G. Recognition and management of depression in general practice: consensus statement. BMJ. 1992 Nov 14;305(6863):1198–1202. doi: 10.1136/bmj.305.6863.1198. [DOI] [PMC free article] [PubMed] [Google Scholar]
- Piccinelli M., Wilkinson G. Outcome of depression in psychiatric settings. Br J Psychiatry. 1994 Mar;164(3):297–304. doi: 10.1192/bjp.164.3.297. [DOI] [PubMed] [Google Scholar]
- Robins L. N., Helzer J. E., Croughan J., Ratcliff K. S. National Institute of Mental Health Diagnostic Interview Schedule. Its history, characteristics, and validity. Arch Gen Psychiatry. 1981 Apr;38(4):381–389. doi: 10.1001/archpsyc.1981.01780290015001. [DOI] [PubMed] [Google Scholar]
- Schulz K. F., Chalmers I., Hayes R. J., Altman D. G. Empirical evidence of bias. Dimensions of methodological quality associated with estimates of treatment effects in controlled trials. JAMA. 1995 Feb 1;273(5):408–412. doi: 10.1001/jama.273.5.408. [DOI] [PubMed] [Google Scholar]
- Schwartz J. A., Speed N. M., Brunberg J. A., Brewer T. L., Brown M., Greden J. F. Depression in stroke rehabilitation. Biol Psychiatry. 1993 May 15;33(10):694–699. doi: 10.1016/0006-3223(93)90118-w. [DOI] [PubMed] [Google Scholar]
- Song F., Freemantle N., Sheldon T. A., House A., Watson P., Long A., Mason J. Selective serotonin reuptake inhibitors: meta-analysis of efficacy and acceptability. BMJ. 1993 Mar 13;306(6879):683–687. doi: 10.1136/bmj.306.6879.683. [DOI] [PMC free article] [PubMed] [Google Scholar]
- Spiegelhalter D. J., Gore S. M., Fitzpatrick R., Fletcher A. E., Jones D. R., Cox D. R. Quality of life measures in health care. III: Resource allocation. BMJ. 1992 Nov 14;305(6863):1205–1209. doi: 10.1136/bmj.305.6863.1205. [DOI] [PMC free article] [PubMed] [Google Scholar]
- Staner L., Kerkhofs M., Detroux D., Leyman S., Linkowski P., Mendlewicz J. Acute, subchronic and withdrawal sleep EEG changes during treatment with paroxetine and amitriptyline: a double-blind randomized trial in major depression. Sleep. 1995 Jul;18(6):470–477. [PubMed] [Google Scholar]
- Stewart A. L., Hays R. D., Ware J. E., Jr The MOS short-form general health survey. Reliability and validity in a patient population. Med Care. 1988 Jul;26(7):724–735. doi: 10.1097/00005650-198807000-00007. [DOI] [PubMed] [Google Scholar]
- Upward J. W., Edwards J. G., Goldie A., Waller D. G. Comparative effects of fluoxetine and amitriptyline on cardiac function. Br J Clin Pharmacol. 1988 Oct;26(4):399–402. doi: 10.1111/j.1365-2125.1988.tb03397.x. [DOI] [PMC free article] [PubMed] [Google Scholar]
- Wells K. B., Stewart A., Hays R. D., Burnam M. A., Rogers W., Daniels M., Berry S., Greenfield S., Ware J. The functioning and well-being of depressed patients. Results from the Medical Outcomes Study. JAMA. 1989 Aug 18;262(7):914–919. [PubMed] [Google Scholar]