A Cochrane review [Abstract] 1 included 54 RCTs with a total of 5122 patients. All trials except one were conducted for mild or moderate depression. Thirty studies compared fluvoxamine with tricyclic antidepressives, 5 with heterocyclics (amineptine, maprotiline, mianserin), 10 with SSRIs, 3 with SNRIs (milnacipran, venlafaxine), 4 with newer antidepressants (moclobemide, mirtazapine), one with sulpiride and one four-arm study with amitriptyline, doxepine and paroxetine. The length of trials was a mean of 5.5 weeks (range 2 to 10 weeks). No strong evidence was found to indicate that fluvoxamine was either superior or inferior to other antidepressants regarding response, remission and tolerability. However, differing side effect profiles were evident, especially with regard to gastrointestinal side effects of fluvoxamine when compared to other antidepressants. For example, fluvoxamine was generally associated with a higher incidence of vomiting/nausea (vs. imipramine, OR 2.23, CI 1.59 to 3.14; vs. clomipramine, OR 2.13, CI 1.06 to 4.27; vs. amitriptyline, OR 2.86, CI 1.31 to 2.63).
Comment: The quality of evidence is downgraded by study quality (inadequate allocation concealment, more than 20% loss to follow-up), indirectness (differences in studied patients; patients with severe depression or elderly patients were not included, short follow-up time) and imprecise results (limited study size for each comparison).
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