Sertraline Versus other Antidepressive Agents for Depression

A Cochrane review [Abstract] 1 included 59 studies with patients with major depression. A total of 9303 patients were included in the efficacy analysis and 9950 for safety analysis. Sertraline (50-200 mg daily) was compared with tricyclic antidepressants (TCA) (amitriptyline, nortriptyline, imipramine, dothiepin, clomipramine and desipramine), selective serotonin reuptake inhibitors (SSRI) (fluoxetine, escitalopram, fluvoxamine, paroxetine, citalopram), maprotiline, tianeptine, hypericum, bupropion, reboxetine, nefazodone, trazodone, moclobemide, mirtazapine and venlafaxine. The primary end-point was the number of patients responding to the treatment.

• Sertraline vs. tricyclics (18 RCTs, 2784 participants): There was no difference in the efficacy in acute phase (6 to 12 weeks) or follow-up response (16 to 24 weeks); there was no data on early response (1 to 4 weeks).

• Sertarline vs. heterocyclics (1 RCT, 64 participants): No difference in the efficacy between sertraline and maprotiline was found.

• Sertraline vs. SSRIs (19 RCTs, 2932 participants): sertraline was more effective than fluoxetine in acute phase (6 to 12 weeks) (OR 0.73, 95% CI 0.59 to 0.92; 8 studies, 1352 participants) but there was no difference in the follow-up (16 to 24 weeks) response. There were no differences between sertraline and other SSRIs (fluvoxamine or paroxetine) in the early response (1 to 4 weeks). There was no evidence of differences between sertraline and other SSRIs (citalopram or fluoxetine) in follow-up response (16 to 24 weeks).

• Sertraline vs. newer antidepressants (bupropion, hypericum, mirtazapine, moclobemide, nefazodone, reboxetine, tianeptine, trazodone and venlafaxine; 21 RCTs, 3539 participants): there was no difference in the efficacy in acute phase (6 to 12 weeks) or follow-up response (16 to 24 weeks) (bupropion and moclobemide). There was evidence that sertraline was less effective than mirtazapine in early phase (1 to 4 weeks) (OR 1.40, 95% CI 1.00 to 1.94, 2 studies, 596 participants).

• Sertraline caused more diarrhea than TCAs, escitalopram, bupropion, mirtazapine and hypericum.

Comment: The quality of evidence is downgraded by study quality (inadequate allocation concealment).

References

• Cipriani A, La Ferla T, Furukawa TA, Signoretti A, Nakagawa A, Churchill R, McGuire H, Barbui C. Sertraline versus other antidepressive agents for depression. Cochrane Database Syst Rev 2010 Jan 20;(1):CD006117. [PubMed]