Paroxetine Versus other Anti-Depressive Agents for Depression

Summary

A Cochrane review [Abstract] 1 included 115 studies with a total of 26134 patients with depression. A total of 54 trials enrolled only outpatients, 14 trials only inpatients, and 18 trials both inpatients and outpatients. The majority of included trials (n=100) enrolled patients with a diagnosis of major depression. In 54 studies paroxetine was compared with an older anti-depressant (AD), in 21 studies with another selective serotonine reuptake inhibitor (SSRI), and in 40 studies with a newer or non-conventional AD other than SSRIs. For the primary outcome (patients who responded to treatment), paroxetine was more effective than reboxetine at increasing patients who responded early (1-4 weeks) to treatment (OR: 0.66, 95% CI 0.50 to 0.87, NNT = 16; 3 RCTs, n=1375), and less effective than mirtazapine at 1-4 weeks (OR: 2.39, 95% CI 1.42 to 4.02, NNT = 8; 3 RCTs, n=726). Paroxetine was also less effective than citalopram in improving response to treatment at 6 to 12 weeks (OR: 1.54, 95% CI 1.04 to 2.28, NNT = 9; 1 RCT, n=406). There was no evidence that paroxetine was more or less effective compared with other antidepressants at increasing response to treatment at acute (6 - 12 weeks), early (1- 4 weeks), or longer term follow-up (4 - 6 months). Paroxetine was associated with a lower rate of adverse events than amitriptyline, imipramine and older ADs as a class, but was less well tolerated than agomelatine and hypericum.

Comment: The quality of the evidence is downgraded by indirectness (short follow-up time) and publication bias (mostly commercially funded studies).