Summary of findings 3. Antidepressant compared to antidepressant for psychotic depression.

Antidepressant compared to antidepressant for psychotic depression
Patient or population: adults with psychotic depression Setting: hospital Intervention: antidepressant Comparison: antidepressant
Outcomes	Anticipated absolute effects* (95% CI)		Relative effect (95% CI)	№. of participants (studies)	Certainty of evidence (GRADE)	Comments
	Risk with antidepressant	Risk with antidepressant
Clinical response	See comment		‐	‐	⊕⊝⊝⊝ Very lowa,b,c	Meta‐analysis was not possible due to heterogeneity between the different antidepressants used van den Broek 2004a showed that imipramine may be more effective than fluvoxamine (RR 2.10, 95% CI 1.06 to 4.17) Bruijn 1996 showed that imipramine may be more effective than mirtazapine (RR 3.00, 95% CI 1.01 to 8.95) Zanardi 1996 showed that sertraline may be more effective than paroxetine (RR 3.37, 95% CI 1.19 to 9.57) Zanardi 2000 found no difference between fluvoxamine and venlafaxine (RR 1.50, 95% CI 0.82 to 2.75) Wijkstra 2010 found no difference between imipramine and venlafaxine (RR 1.57, 95% CI 0.93 to 2.67)
Overall dropouts	See comment		‐	‐	⊕⊝⊝⊝ Very lowa,b,c	Wijkstra 2010 found no difference between imipramine and venlafaxine (RR 0.81, 95% CI 0.33 to 2.03) Bruijn 1996 found no difference between imipramine and mirtazapine (RR 0.50, 95% CI 0.19 to 1.31) van den Broek 2004a found no difference between imipramine and fluvoxamine (RR 2.00, 95% CI 0.40 to 9.95) Zanardi 1996 found no difference between sertraline and paroxetine (RR 0.20, 95% CI 0.01 to 3.74) Zanardi 2000 found no difference between fluvoxamine and venlafaxine (RR 0.07, 95% CI 0.00 to 1.20)
Depression remission	See comment		‐	‐	‐	No study reported this outcome
Change in depression severity from baseline	See comment		‐	‐	‐	No study reported this outcome
Quality of life	See comment		‐	‐	‐	No study reported this outcome
Dropouts due to adverse effects	See comment		‐	‐	‐	No study reported this outcome
*The risk in the intervention group (and its 95% confidence interval) is based on the assumed risk in the comparison group and the relative effect of the intervention (and its 95% CI). CI: confidence interval; RR: risk ratio.
GRADE Working Group grades of evidence. High certainty: we are very confident that the true effect lies close to that of the estimate of the effect. Moderate certainty: we are moderately confident in the effect estimate: the true effect is likely to be close to the estimate of the effect, but there is a possibility that it is substantially different. Low certainty: our confidence in the effect estimate is limited: the true effect may be substantially different from the estimate of the effect. Very low certainty: we have very little confidence in the effect estimate: the true effect is likely to be substantially different from the estimate of effect.

^aDowngraded one level for imprecision due to small sample size.

^bDowngraded one level for imprecision as CIs are consistent with appreciable benefit and appreciable harm.

^cDowngraded one level for high risk of publication bias.