The quality of evidence is downgraded by study limitations (unclear allocation concealment, high dropout rate) and by inconsistency.
A Cochrane review [Abstract] 1 included 14 studies with a total of 1 364 subjects. Six of these compared antidepressants and placebo, 3 compared two antidepressants and one three-armed study compared two antidepressants and a placebo arm.
For acute phase treatment response (6 to 12 weeks), antidepressants reduced depressive symptoms compared with placebo when measured as a continuous outcome (SMD -0.52, 95% CI -0.92 to -0.12; statistical heterogeneity I2 =74%; 7 studies, n=511) and when measured as a proportion of people who had depression at the end of the study (RR 0.74, 95% CI 0.57 to 0.96; statistical heterogeneity I2 =58%; 5 studies, n=662). There was no statistically significant difference between selective serotonin reuptake inhibitors (SSRIs) and tricyclic antidepressants (TCAs) or mirtazapine versus TCAs.
No studies reported data on the follow-up response (more than 12 weeks). Antidepressants did not cause more dropouts compared with placebo (RR 0.85, 95% CI 0.52 to 1.38, 9 studies, n=889), and there was no difference between SSRIs and TCAs either regarding this endpoint (RR 0.83, 95% CI 0.53 to 1.22, 3 RCTs, n=237).
Primary/Secondary Keywords