Table 4.
Adjusteda analyses comparing any antidepressant with fluoxetine at 2 months (short term) and 12 months (long term)
| Acceptability, at 2 months | Acceptability, at 12 months | Tolerability, at 2 months | Tolerability, at 12 months | Safety, at 2 months | Safety, at 12 months | Response 50% reduction on PHQ-9, at 2 months | Response, 50% reduction on PHQ-9, at 12 months | Remission, scoring < 5 on PHQ-9, at 2 months |
Remission, scoring < 5 on PHQ-9, at 12 months |
|
|---|---|---|---|---|---|---|---|---|---|---|
| Antidepressant | N = 673 176 aORa (99% CI) | N = 673 155 aORa (99% CI) | N = 673 160 aORa (99% CI) | N = 673 170 aORa (99% CI) | N = 673 174 aORa (99% CI) | N = 673 176 aORa (99% CI) | N = 669 679 aORa (99% CI) | N = 669 679 aORa (99% CI) | N = 669 679 aORa (99% CI) | N = 669 679 aORa (99% CI) |
| Fluoxetine (index) | 1.00 | 1.00 | 1.00 | 1.00 | 1.00 | 1.00 | 1.00 | 1.00 | 1.00 | 1.00 |
| Amitriptyline | 2.92 (2.75, 3.09) | 2.27 (2.06, 2.50) | 3.36 (3.12, 3.63) | 1.86 (1.75, 1.98) | 1.55 (1.46, 1.65) | 1.42 (1.33, 1.51) | 0.39 (0.30, 0.50) | 0.78 (0.61, 1.02) | 0.42 (0.33, 0.54) | 0.80 (0.60, 1.07) |
| Clomipramine | 1.54 (1.26, 1.89) | 1.11 (0.74, 1.67) | 1.92 (1.31, 2.81) | 1.30 (0.94, 1.8) | 1.24 (0.99, 1.55) | 1.09 (0.85, 1.39) | − | − | − | − |
| Dosulepin | 1.35 (1.27, 1.43) | 1.29 (1.17, 1.41) | 1.48 (1.35, 1.63) | 1.18 (1.09, 1.27) | 1.12 (1.03, 1.21) | 1.10 (1.01, 1.19) | 0.71 (0.55, 0.91) | 1.02 (0.61, 1.69) | 0.73 (0.57, 0.93) | 1.05 (0.64, 1.74) |
| Doxepin | 1.60 (1.13, 2.25) | 1.23 (0.81, 1.88) | 1.94 (1.09, 3.46) | 1.28 (0.76, 2.16) | 1.04 (0.69, 1.55) | 1.07 (0.77, 1.50) | − | − | − | − |
| Imipramine | 1.58 (1.24, 2.02) | 1.27 (0.90, 1.80) | 1.92 (1.29, 2.88) | 1.51 (1.15, 1.97) | 1.05 (0.83, 1.33) | 1.13 (0.91, 1.40) | − | − | − | − |
| Lofepramine | 1.62 (1.50, 1.76) | 2.06 (1.77, 2.41) | 1.64 (1.44, 1.87) | 1.27 (1.14, 1.41) | 1.15 (1.04, 1.28) | 1.11 (1.00, 1.23) | 0.70 (0.48, 1.03) | 0.64 (0.27, 1.56) | 0.72 (0.51, 1.01) | 0.64 (0.26, 1.58) |
| Maprotiline | 2.09 (0.37, 11.9) | 1 | 4.62 (1.16, 18.5) | 2.64 (0.84, 8.28) | 1.40 (0.25, 7.93) | 1.35 (0.21, 8.51) | − | − | − | − |
| Mianserin | 3.04 (1.08, 8.51) | 9.34 (0.65, 133) | 2.13 (0.72, 6.28) | 1.20 (0.49, 2.92) | 0.96 (0.52, 1.76) | 1.21 (0.62, 2.35) | − | − | − | − |
| Nortriptyline | 2.50 (1.83, 3.41) | 2.20 (1.27, 3.80) | 3.66 (2.62, 5.12) | 2.46 (1.80, 3.35) | 1.56 (1.19, 2.06) | 1.28 (0.93, 1.77) | − | − | − | − |
| Trimipramine | 1.60 (1.15, 2.23) | 1.52 (0.84, 2.76) | 2.26 (1.37, 3.72) | 1.48 (1.01, 2.19) | 1.00 (0.71, 1.42) | 1.07 (0.77, 1.50) | − | − | − | − |
| Moclobemide | 0.98 (0.52, 1.86) | 0.92 (0.33, 2.59) | 0.33 (0.03, 4.02) | 1.80 (0.80, 4.04) | 0.88 (0.46, 1.71) | 0.87 (0.47, 1.62) | − | − | − | − |
| Phenelzine | 1.70 (0.32, 8.98) | 0.47 (0.07, 3.30) | 1 | 0.93 (0.06, 14.2) | 1.31(0.24, 7.22) | 0.76 (0.15, 3.88) | − | − | − | − |
| Citalopram | 0.95 (0.92, 0.97) | 0.78 (0.76, 0.81) | 1.03 (0.99, 1.08) | 1.09 (1.06, 1.13) | 1.17 (1.12, 1.21) | 1.12 (1.08, 1.16) | 1.04 (0.98, 1.10) | 1.12 (1.01, 1.23) | 1.04 (0.98, 1.10) | 1.12 (1.01, 1.25) |
| Escitalopram | 0.97 (0.91, 1.02) | 0.83 (0.78, 0.90) | 1.04 (0.94, 1.15) | 1.07 (0.99, 1.16) | 1.15 (1.05, 1.26) | 1.07 (0.97, 1.19) | 0.88 (0.75, 1.04) | 1.07 (0.77, 1.48) | 0.88 (0.74, 1.05) | 1.08 (0.77, 1.53) |
| Fluvoxamine | 1.18 (0.74, 1.87) | 1.12 (0.53, 2.39) | 1.89 (0.86, 4.18) | 1.32 (0.71, 2.46) | 0.80 (0.47, 1.34) | 0.73 (0.37, 1.46) | − | − | − | − |
| Paroxetine | 1.09 (1.05, 1.14) | 0.84 (0.79, 0.90) | 1.18 (1.08, 1.28) | 1.07 (1.01, 1.14) | 1.11 (1.04, 1.18) | 1.01 (0.94, 1.07) | 0.83 (0.68, 1.02) | 0.98 (0.66, 1.44) | 0.86 (0.69, 1.07) | 1.00 (0.69, 1.45) |
| Sertraline | 1.00 (0.97, 1.03) | 0.84 (0.81, 0.87) | 1.12 (1.06, 1.18) | 1.11 (1.07, 1.15) | 1.25 (1.20, 1.31) | 1.14 (1.09, 1.19) | 1.02 (0.93, 1.11) | 1.15 (0.93, 1.42) | 1.02 (0.93, 1.12) | 1.15 (0.92, 1.43) |
| Agomelatine | 1.56 (0.60, 4.07) | 2.12 (0.29, 15.5) | 1.46 (0.22, 9.66) | 0.94 (0.20, 4.39) | 1.17 (0.47, 2.91) | 0.73 (0.26, 2.04) | − | − | − | − |
| Duloxetine | 1.24 (1.06, 1.46) | 0.93 (0.75, 1.15) | 1.59 (1.20, 2.12) | 1.61 (1.33, 1.96) | 1.27 (1.08, 1.50) | 1.21 (0.99, 1.48) | 0.79 (0.51, 1.23) | 0.41 (0.06, 2.73) | 0.80 (0.53, 1.2) | 0.39 (0.05, 3.08) |
| Mirtazapine | 1.35 (1.31, 1.41) | 1.22 (1.16, 1.29) | 1.40 (1.30, 1.49) | 1.21 (1.15, 1.27) | 1.21 (1.15, 1.27) | 1.14 (1.08, 1.19) | 0.78 (0.71, 0.87) | 0.92 (0.75, 1.14) | 0.79 (0.71, 0.88) | 0.93 (0.73, 1.18) |
| Nefazodone | 1.16 (0.81, 1.66) | 0.93 (0.55, 1.57) | 1.17 (0.52, 2.63) | 1.20 (0.67, 2.17) | 0.74 (0.48, 1.12) | 0.98 (0.67, 1.42) | − | − | − | − |
| Reboxetine | 2.07 (1.16, 3.67) | 1.77 (0.76, 4.09) | 1.92 (1.09, 3.39) | 1.30 (0.89, 1.89) | 1.00 (0.73, 1.36) | 0.97 (0.70, 1.35) | − | − | − | − |
| Trazodone | 1.74 (1.27, 2.40) | 1.52 (1.21, 1.90) | 1.99 (1.59, 2.49) | 1.42 (1.25, 1.61) | 1.37 (1.19, 1.58) | 1.26 (1.08, 1.48) | 0.62 (0.47, 0.83) | 0.73 (0.35, 1.52) | 0.63 (0.43, 0.93) | 0.75 (0.36, 1.58) |
| Venlafaxine | 1.45 (1.33, 1.57) | 1.13 (0.98, 1.29) | 1.57 (1.35, 1.84) | 1.30 (1.16, 1.46) | 1.09 (1.00, 1.19) | 1.04 (0.94, 1.14) | 0.79 (0.52, 1.17) | 0.76 (0.39, 1.45) | 0.80 (0.55, 1.16) | 0.76 (0.37, 1.58) |
| Vortioxetine | 1.08 (0.48, 2.42) | 1.13 (0.28, 4.52) | 0.48 (0.04, 6.52) | 0.87 (0.23, 3.36) | 0.77 (0.35, 1.69) | 0.66 (0.30, 1.46) | − | − | − | − |
The numbers in each cell correspond to the estimated adjusted odds ratios (aORs) for each outcome and antidepressant treatment compared to fluoxetine. This was adjusted for clusters in general practices and for gender, age, baseline severity, depression subtype, year of diagnosis, body mass index (BMI), smoking status, daily alcohol intake, ethnicity, Townsend quintile, region of England, comorbidities at baseline (coronary heart disease, stroke/transient ischaemic attack, diabetes, cancer, epilepsy/seizures, hypothyroidism, osteoarthritis/rheumatoid arthritis, suicidal ideation/behaviour or self-harm, asthma/chronic obstructive pulmonary disease [COPD] , osteoporosis, liver disease, renal disease, anxiety) and use of other drugs at baseline (anticonvulsants, hypnotics/anxiolytics, antihypertensive drugs, aspirin, statins, anticoagulants, non-steroidal anti-inflammatory drugs, bisphosphonates, oral contraceptives/hormone replacement therapy). Amoxapine, isocarboaxazid, tranylcypromine and tryptophan, which had fewer than five patients, were excluded from the table to comply with QResearch data management guidelines. The shading corresponds to the strength of statistical evidence regarding the effects versus fluoxetine. A dark cell with background lines indicates strong evidence (P < 0.001) that the corresponding drug performs better than fluoxetine for the corresponding outcome. Conversely, a dark cell without lines indicates strong evidence (P < 0.001) that the drug performs worse than fluoxetine. Colours closer to white indicate lack of evidence on whether the drug performs better or worse than fluoxetine (see legend below).
Legend
