A Cochrane review [Abstract] 1 included 3 RCTs with 204 participants for efficacy and 2 RCTs and 5 observational studies with a total of 249 participants for adverse effects. The trials were between 5 and 8 weeks of duration. All participants in the studies met DSM (Diagnostic and Statistics Manual of Mental Disorders) criteria for seasonal affective disorder SAD. The average age ranged from 34 to 42 years, and the majority of participants were female (66% to 100%).
•Fluoxetine vs. placebo (one trial, n=68): fluoxetine was not significantly more effective than placebo in achieving clinical response (RR 1.62, 95% CI 0.92 to 2.83). The number of adverse events was similar in both groups.
•Fluoxetine vs. light therapy (two trials, n=136): The meta-analysis of the results showed fluoxetine and light therapy to be approximately equal in treating seasonal depression (RR of response 0.98, 95% CI 0.77 to 1.24, RR of remission 0.81, 95% CI 0.39 to 1.71). The number of adverse events was similar in both groups.
There were no eligible studies comparing second generation antidepressants (SGA) with another SGA or with psychotherapy.
•Adverse effect data was reported on a total of 249 participants who received bupropion, fluoxetine, escitalopram, duloxetine, nefazodone, reboxetine, light therapy, or placebo. Between 0% and 100% of participants who received an SGA suffered an adverse event, and between 0% and 25% of participants withdrew from the study due to adverse events.
Comment: The quality of the evidence is downgraded by study quality (inadequate allocation concealment, high attrition rate, short follow-up time), imprecise results (limited study size for each comparison) and indirectness (patient-important outcomes scarcely available, few results on any parameters).
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