Table 1.
Summary estimates of OR for efficacy (response rate) and acceptability (withdrawal rate) in meta-analyses of direct comparisons between SSRIs and venlafaxine and multiple-treatments meta-analysis (MTM) between SSRIs and venlafaxine (see note below).[43]
| Comparisons | Number of studies included | Number of people randomised | Efficacy (ORs >1 favour the first antidepressant) | Acceptability (ORs <1 favour the first antidepressant) | |||||
| Direct comparisons | MTM (direct and indirect comparison) | Direct comparisons | MTM (direct and indirect comparison) | ||||||
| Response rate (responders / total randomised) | OR (95% CI) | OR (95% CrI) | Withdrawal rate (withdrawals / total randomised) | OR (95% CI) | OR (95% CrI) | ||||
| Citalopram v | Escitalopram | 5 | 1604 | 319/622 v 426/725 | 0.68 (0.53 to 0.87) | 0.84 (0.70 to 1.01) | 127/750 v 141/854 | 1.17 (0.83 to 1.64) | 1.07 (0.86 to 1.31) |
| Fluoxetine | 3 | 740 | 216/364 v 219/376 | 1.05 (0.77 to 1.43) | 1.10 (0.93 to 1.31) | 75/364 v 68/376 | 1.17 (0.80 to 1.70) | 0.90 (0.73 to 1.09) | |
| Fluvoxamine | 1 | 217 | 33/108 v 31/109 | 1.11 (0.62 to 1.98) | 1.13 (0.86 to 1.47) | 22/108 v 29/109 | 0.71 (0.37 to 1.33) | 0.73 (0.54 to 0.99) | |
| Paroxetine | 1 | 406 | 77/199 v 102/207 | 1.54 (1.04 to 2.28) | 1.08 (0.90 to 1.30) | 43/207 v 41/199 | 1.01 (0.62 to 1.63) | 0.81 (0.65 to 1.01) | |
| Sertraline | 2 | 615 | 139/200 v 136/200 | 0.93 (0.61 to 1.42) | 0.88 (0.72 to 1.07) | 60/307 v 82/308 | 0.67 (0.46 to 0.98) | 1.02 (0.81 to 1.28) | |
| Venlafaxine | 1 | 151 | 50/75 v 49/76 | 1.10 (0.56 to 2.16) | 0.86 (0.71 to 1.05) | – | – | 0.84 (0.67 to 1.06) | |
| Escitalopram v | Citalopram | 5 | 1604 | 426/725 v 319/622 | 1.47 (1.15 to 1.90) | 1.19 (0.99 to 1.43) | 141/854 v 127/750 | 0.86 (0.61 to 1.20) | 0.93 (0.76 to 1.16) |
| Fluoxetine | 2 | 543 | 143/276 v 126/267 | 1.23 (0.87 to 1.74) | 1.32 (1.12 to 1.55) | 66/276 v 68/267 | 0.98 (0.37 to 2.56) | 0.84 (0.70 to 1.01) | |
| Fluvoxamine | – | – | – | – | 1.35 (1.02 to 1.76) | – | – | 0.69 (0.50 to 0.94) | |
| Paroxetine | 2 | 784 | 274/398 v 255/386 | 1.12 (0.76 to 1.65) | 1.30 (1.10 to 1.53) | 40/398 v 50/386 | 0.75 (0.48 to 1.17) | 0.76 (0.62 to 0.93) | |
| Sertraline | 2 | 489 | 144/243 v 152/246 | 0.90 (0.62 to 1.30) | 1.06 (0.88 to 1.27) | 47/243 v 40/246 | 1.24 (0.77 to 1.97) | 0.95 (0.77 to 1.19) | |
| Venlafaxine | 2 | 495 | 172/249 v 160/246 | 1.21 (0.69 to 2.11) | 1.03 (0.86 to 1.24) | 52/249 v 56/246 | 0.90 (0.58 to 1.39) | 0.78 (0.64 to 0.97) | |
| Fluoxetine v | Citalopram | 3 | 740 | 219/376 v 216/364 | 0.95 (0.70 to 1.29) | 0.91 (0.76 to 1.08) | 68/376 v 75/364 | 0.86 (0.59 to 1.25) | 1.11 (0.92 to 1.37) |
| Escitalopram | 2 | 543 | 126/267 v 143/276 | 0.81 (0.57 to 1.15) | 0.76 (0.65 to 0.89) | 68/267 v 66/276 | 1.02 (0.39 to 2.67) | 1.19 (0.99 to 1.43) | |
| Fluvoxamine | 2 | 284 | 83/143 v 83/141 | 0.97 (0.60 to 1.55) | 1.02 (0.81 to 1.30) | 28/143 v 31/141 | 0.85 (0.48 to 1.52) | 0.82 (0.62 to 1.07) | |
| Paroxetine | 13 | 2806 | 771/1287 v 740/1277 | 1.01 (0.82 to 1.24) | 0.98 (0.86 to 1.12) | 447/1406 v 468/1400 | 0.93 (0.79 to 1.09) | 0.91 (0.79 to 1.05) | |
| Sertraline | 8 | 1352 | 344/666 v 406/686 | 0.70 (0.56 to 0.88) | 0.80 (0.69 to 0.93) | 151/546 v 135/568 | 1.25 (0.88 to 1.77) | 1.14 (0.96 to 1.36) | |
| Venlafaxine | 12 | 2446 | 607/1126 v 679/1116 | 0.74 (0.62 to 0.88) | 0.78 (0.68 to 0.90) | 290/1226 v 302/1220 | 0.94 (0.78 to 1.13) | 0.94 (0.81 to 1.09) | |
| Fluvoxamine v | Citalopram | 1 | 217 | 31/109 v 33/108 | 0.90 (0.50 to 1.62) | 0.88 (0.68 to 1.16) | 29/109 v 22/108 | 1.42 (0.75 to 2.66) | 1.37 (1.01 to 1.85) |
| Escitalopram | – | – | – | – | 0.74 (0.57 to 0.98) | – | – | 1.45 (1.06 to 2.00) | |
| Fluoxetine | 2 | 284 | 83/141 v 83/143 | 1.03 (0.64 to 1.66) | 0.98 (0.77 to 1.23) | 31/141 v 28/143 | 1.17 (0.66 to 2.09) | 1.22 (0.93 to 1.61) | |
| Paroxetine | 3 | 281 | 72/143 v 77/138 | 0.83 (0.51 to 1.34) | 0.96 (0.76 to 1.23) | 42/143 v 38/138 | 1.08 (0.62 to 1.85) | 1.10 (0.84 to 1.47) | |
| Sertraline | 2 | 185 | 48/89 v 49/96 | 1.21 (0.53 to 2.75) | 0.79 (0.61 to 1.01) | 22/89 v 12/96 | 1.47 (0.19 to 11.11) | 1.38 (1.03 to 1.89) | |
| Venlafaxine | 1 | 111 | 14/34 v 48/77 | 0.42 (0.19 to 0.96) | 0.77 (0.59 to 0.99) | 13/34 v 18/77 | 2.03 (0.85 to 4.84) | 1.14 (0.86 to 1.54) | |
| Paroxetine v | Citalopram | 1 | 406 | 77/199 v 102/207 | 0.65 (0.44 to 0.96) | 0.93 (0.77 to 1.11) | 41/199 v 43/207 | 0.99 (0.61 to 1.60) | 1.23 (0.99 to 1.54) |
| Escitalopram | 2 | 784 | 255/386 v 274/398 | 0.89 (0.61 to 1.32) | 0.77 (0.65 to 0.91) | 50/386 v 40/398 | 1.33 (0.85 to 2.07) | 1.32 (1.08 to 1.61) | |
| Fluoxetine | 13 | 2806 | 740/1277 v 771/1287 | 0.99 (0.85 to 1.22) | 1.02 (0.89 to 1.16) | 468/1400 v 447/1406 | 1.08 (0.92 to 1.26) | 1.10 (0.95 to 1.27) | |
| Fluvoxamine | 3 | 281 | 77/138 v 72/143 | 1.20 (0.74 to 1.96) | 1.04 (0.81 to 1.32) | 38/138 v 42/143 | 0.93 (0.54 to 1.60) | 0.91 (0.68 to 1.19) | |
| Sertraline | 4 | 664 | 204/325 v 241/339 | 0.57 (0.30 to 1.07) | 0.82 (0.69 to 0.96) | 75/325 v 69/339 | 1.47 (0.65 to 3.33) | 1.25 (1.04 to 1.52) | |
| Venlafaxine | 1 | 361 | 105/178 v 113/183 | 0.89 (0.58 to 1.36) | 0.79 (0.67 to 0.94) | 52/178 v 47/183 | 1.19 (0.75 to 1.90) | 1.03 (0.86 to 1.24) | |
| Sertraline v | Citalopram | 2 | 615 | 139/200 v 136/200 | 1.07 (0.70 to 1.64) | 1.14 (0.93 to 1.39) | 82/308 v 60/307 | 1.49 (1.02 to 2.18) | 0.98 (0.78 to 1.23) |
| Escitalopram | 2 | 489 | 152/246 v 144/243 | 1.12 (0.77 to 1.61) | 0.94 (0.79 to 1.14) | 40/246 v 47/243 | 0.81 (0.51 to 1.29) | 1.05 (0.84 to 1.30) | |
| Fluoxetine | 8 | 1352 | 406/686 v 344/666 | 1.42 (1.13 to 1.78) | 1.25 (1.08 to 1.45) | 135/568 v 151/546 | 0.80 (0.56 to 1.14) | 0.88 (0.74 to 1.04) | |
| Fluvoxamine | 2 | 185 | 49/96 v 48/89 | 0.83 (0.36 to 1.88) | 1.27 (0.99 to 1.64) | 12/96 v 22/89 | 0.68 (0.09 to 5.15) | 0.72 (0.53 to 0.97) | |
| Paroxetine | 4 | 664 | 241/339 v 204/325 | 1.76 (0.93 to 3.32) | 1.22 (1.04 to 1.45) | 69/339 v 75/325 | 0.68 (0.30 to 1.54) | 0.80 (0.66 to 0.96) | |
| Venlafaxine | 5 | 611 | 177/303 v 190/308 | 0.87 (0.59 to 1.29) | 0.98 (0.82 to 1.16) | 49/303 v 70/308 | 0.56 (0.24 to 1.33) | 0.82 (0.67 to 1.00) | |
| Venlafaxine v | Citalopram | 1 | 151 | 49/76 v 50/75 | 0.91 (0.46 to 1.78) | 1.16 (0.95 to 1.41) | – | – | 1.19 (0.94 to 1.49) |
| Escitalopram | 2 | 495 | 160/246 v 172/249 | 0.82 (0.47 to 1.44) | 0.97 (0.81 to 1.16) | 56/246 v 52/249 | 1.12 (0.72 to 1.73) | 1.28 (1.03 to 1.56) | |
| Fluoxetine | 11 | 2446 | 679/1116 v 607/1126 | 1.36 (1.14 to 1.62) | 1.28 (1.11 to 1.47) | 302/1220 v 290/1226 | 1.07 (0.88 to 1.29) | 1.06 (0.92 to 1.23) | |
| Fluvoxamine | 1 | 111 | 48/77 v 14/34 | 2.36 (1.04 to 5.38) | 1.30 (1.01 to 1.69) | 18/77 v 13/34 | 0.49 (0.21 to 1.18) | 0.88 (0.65 to 1.16) | |
| Paroxetine | 1 | 361 | 113/183 v 105/178 | 1.12 (0.74 to 1.71) | 1.27 (1.06 to 1.49) | 47/183 v 52/178 | 0.84 (0.53 to 1.33) | 0.97 (0.81 to 1.16) | |
| Sertraline | 5 | 611 | 190/308 v 177/303 | 1.15 (0.78 to 1.69) | 1.02 (0.86 to 1.22) | 70/308 v 49/303 | 1.78 (0.75 to 4.18) | 1.22 (1.00 to 1.49) | |
Statistically significant results for direct and indirect comparisons are in bold: for efficacy analysis, ORs >1 favour the first antidepressant; for acceptability, ORs <1 favour the first antidepressant. Note: although we have just presented results for SSRIs and venlafaxine in this table, it should be noted that bupropion, duloxetine, milnacipran, mirtazapine, and reboxetine were also included in the multiple-treatments meta-analysis (MTM) and will have contributed to the effect size reported in the MTM analysis. In the analysis of comparative efficacy for the MTM analysis, fluoxetine was selected as the reference drug. For the MTM analysis, to obtain ORs for comparisons in the opposite directions, the reciprocals have been taken (e.g., the OR for citalopram compared with fluoxetine is 1.10; the OR for fluoxetine compared with citalopram is 1/1.10 = 0.91). CrI, credibility interval.