A Cochrane review [Abstract] 1 included 29 studies. No differences in efficacy when comparing classes of antidepressants were found. Tricyclic antidepressants (TCAs) compared less favourably with selective serotonin reuptake inhibitors (SSRIs) in terms of numbers of patients withdrawn irrespective of reason (RR 1.24; 95% CI 1.04 to 1.47) and number withdrawn due to side effects (RR 1.30; 95% CI 1.02 to 1.64). Subgroup analyses demonstrated that TCA related antidepressants had similar withdrawal rates to SSRIs irrespective of reason of withdrawal (RR 1.49; 95% CI 0.74 to 2.98) or withdrawal due to side effects (RR 1.07; 95% CI 0.43 to 2.70). A small increased profile of gastro-intestinal and neuropsychiatric side effects associated with classical TCAs was found in qualitative analysis.
Another Cochrane review [Abstract] 2 included 17 studies with a total of 1 326 subjects. Only comparisons to placebo were included. All studied antidepressants were effective in the treatment of depression in elderly, the standardised effect sizes for three groups of antidepressants were: TCAs; OR 0.32 (95% CI 0.21 to 0.47), SSRIs; OR 0.51 (95% CI 0.36 to 0.72), MAOIs; 0.17 (95% CI 0.07 to 0.39). The adverse effects were not reported in the review. The authors conclude that antidepressants (TCAs, SSRIs and MAOIs) are effective in the treatment of depression in elderly as compared with placebo.
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