Table 2.

Quality assessment of trials comparing selective serotonin reuptake inhibitors (SSRIs) with tricyclic antidepressants for treatment of moderate depression in primary care²

	Quality assessment					Summary of findings
					Other modifying factors*	No of patients		Effect
No of studies	Design	Quality	Consistency	Directness		SSRIs	Tricyclics	Relative (95% CI)	Absolute	Quality	Importance
Depression severity (measured with Hamilton Depression Rating Scale after 4 to 12 weeks)
Citalopram (8)	Randomised controlled trials	No serious limitations	No important inconsistency	Some uncertainty about directness (outcome measure)†	None	5044	4510	WMD 0.034 (−0.007 to 0.075)	No difference	Moderate	Critical
Fluoxetine (38)
Fluvoxamine (25)
Nefazodone (2)
Paroxetine (18)
Sertraline (4)
Venlafaxine (4)
Transient side effects resulting in discontinuation of treatment
Citalopram (8)	Randomised controlled trials	No serious limitations	No important inconsistency	Direct	None	1948/703 2 (28%)	2072/6334 (33%)	RRR 13% (5% to 20%)	5/100	High	Critical
Fluoxetine (50)
Fluvoxamine (27)
Nefazodone (4)
Paroxetine (23)
Sertraline (6)
Venlafaxine (5)
Poisoning fatalities§
UK Office for National Statistics (1)	Observational data	Serious limitation‡	Only one study	Direct	Very strong association	1/100 000/year of treatment	58/100 000/year of treatment	RRR 98% (97% to 99%)§	6/10 000	Moderate	Critical

WMD = weighted mean difference, RRR = relative risk reduction.

^*Imprecise or sparse data, a strong or very strong association, high risk of reporting bias, evidence of a dose-response gradient, effect of plausible residual confounding.

^†There was uncertainty about the directness of the outcome measure because of the short duration of the trials.

^‡It is possible that people at lower risk were more likely to have been given SSRIs and it is uncertain if changing antidepressant would have deterred suicide attempts.

^§There is uncertainty about the baseline risk for poisoning fatalities.