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Evidence summaries

Duloxetine Versus other Anti-Depressive Agents for Depression

Duloxetine does not appear to provide an advantage in efficacy over other antidepressive agents for the acute-phase treatment of major depression. In terms of acceptability and tolerability duloxetine appears to be worse than escitalopram and venlafaxine. Level of evidence: "B"

Summary

A Cochrane review [Abstract] 1 included 16 studies with a total of 5735 subjects. All studies included patients with major depressive disorder (MDD) only, 13 trials enrolled only out-patients. Eleven studies (n=3304) compared duloxetine with one selective serotonin reuptake inhibitor (SSRI) (paroxetine=6, escitalopram=3 and fluoxetine=2), 4 studies (n=1978) with a newer antidepressants (venlafaxine=3, desvenlafaxine=1) and one study (n=453) compared duloxetine with quetiapine, an antipsychotic drug which is also used as an antidepressive agent. No studies were found comparing duloxetine with tricyclic antidepressants. The pooled confidence intervals were rather wide and there were no statistically significant differences in efficacy when comparing duloxetine with other antidepressants. However, when compared with escitalopram or venlafaxine, there was a higher rate of drop out due to any cause in the patients randomised to duloxetine (OR 1.62; 95% CI 1.01 to 2.62; 3 trials, n=1120 and OR 1.56; 95% CI 1.14 to 2.15; 3 trials, n=1051, respectively). There was also some weak evidence suggesting that patients taking duloxetine experienced more adverse events than paroxetine (OR 1.24; 95% CI 0.99 to 1.55; 6 trials, n=1870).

Comment: The quality of the evidence is downgraded by study quality (unclear allocation concealment, more than 20% loss to follow-up).

Clinical comments

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    References

    • Cipriani A, Koesters M, Furukawa TA et al. Duloxetine versus other anti-depressive agents for depression. Cochrane Database Syst Rev 2012;10:CD006533. [PubMed]

Primary/Secondary Keywords