Consider using sertraline in acute phase of major depression.
A systematic review 1 included 117 studies with a total of 25 928 subjects. The trials compared any of the following antidepressants at therapeutic dose range for the acute treatmentof unipolar major depression in adults: bupropion, citalopram, duloxetine, escitalopram, fluoxetine, fluvoxamine,milnacipran, mirtazapine, paroxetine, reboxetine, sertraline, and venlafaxine. Acute treatment was defined as 8-week treatment forthe analyses. Inequalities in dosing, that could affect comparativeefficacy, were taken into consideration. The main outcomes were the proportionof patients who responded to or dropped out of the treatment. Analysis was done on an intention-to-treatbasis.Mirtazapine, escitalopram, venlafaxine, and sertraline were significantly more efficacious than duloxetine(OR 1,39, 1,33, 1,30 and 1,27, respectively), fluoxetine (1,37, 1,32, 1,28, and 1,25, respectively),fluvoxamine (1,41, 1,35, 1,30, and 1,27, respectively), paroxetine (1,35, 1,30, 1,27, and 1,22, respectively), andreboxetine (2,03, 1,95, 1,89, and 1,85, respectively). Reboxetine was significantly less efficacious than all the otherantidepressants tested. Escitalopram and sertraline showed the best profile of acceptability, leading to significantlyfewer discontinuations than did duloxetine, fluvoxamine, paroxetine, reboxetine, and venlafaxine.
Comment: The quality of evidence is downgraded by suspected publication bias (mostly commercially funded studies).
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