Skip to main page content
U.S. flag

An official website of the United States government

Dot gov

The .gov means it’s official.
Federal government websites often end in .gov or .mil. Before sharing sensitive information, make sure you’re on a federal government site.

Https

The site is secure.
The https:// ensures that you are connecting to the official website and that any information you provide is encrypted and transmitted securely.

Access keys NCBI Homepage MyNCBI Homepage Main Content Main Navigation
Meta-Analysis
. 2003 May 10;326(7397):1014.
doi: 10.1136/bmj.326.7397.1014.

Efficacy and tolerability of selective serotonin reuptake inhibitors compared with tricyclic antidepressants in depression treated in primary care: systematic review and meta-analysis

Steve MacGillivray  1 , Bruce Arroll, Simon Hatcher, Simon Ogston, Ian Reid, Frank Sullivan, Brian Williams, Iain Crombie
Affiliations
Meta-Analysis

Efficacy and tolerability of selective serotonin reuptake inhibitors compared with tricyclic antidepressants in depression treated in primary care: systematic review and meta-analysis

Steve MacGillivray et al. BMJ. .

Abstract

Objective: To compare the efficacy and tolerability of tricyclic antidepressants with selective serotonin reuptake inhibitors in depression in primary care.

Design: Systematic review and meta-analysis of randomised controlled trials.

Data sources: Register of the Cochrane Collaboration's depression, anxiety, and neurosis group. Reference lists of initial studies and other relevant review papers. Selected authors and experts.

Selection of studies: Studies had to meet minimum requirements on: adequacy of sample size, adequate allocation concealment, clear description of treatment, representative source of subjects, use of diagnostic criteria or clear specification of inclusion criteria, details regarding number and reasons for withdrawal by group, and outcome measures described clearly or use of validated instruments.

Main outcome measures: Standardised mean difference of final mean depression scores and relative risk of response when using the clinical global impression score. Relative risk of withdrawing from treatment at any time, and the number withdrawing due to side effects.

Results: 11 studies (2951 participants) compared a selective serotonin reuptake inhibitor with a tricyclic antidepressant. Efficacy between selective serotonin reuptake inhibitors and tricyclics did not differ significantly (standardised weighted mean difference, fixed effects 0.07, 95% confidence interval -0.02 to 0.15; z=1.59, P<0.11). Significantly more patients receiving a tricyclic withdrew from treatment (relative risk 0.78, 95% confidence interval 0.68 to 0.90; z=3.37, P<0.0007) and withdrew specifically because of side effects (0.73, 0.60 to 0.88; z=3.24, P<0.001). Most studies included were small and supported by commercial funding. Many studies were of low methodological quality or did not present adequate data for analysis, or both, and were of short duration, typically six to eight weeks.

Conclusion: The evidence on the relative efficacy of selective serotonin reuptake inhibitors and tricyclic antidepressants in primary care is sparse and of variable quality. The study setting is likely to be an important factor in assessing the efficacy and tolerability of treatment with antidepressant drugs.

PubMed Disclaimer

Figures

Figure 1
Figure 1
Number of studies yielded by search strategy. References to studies can be found on bmj.com
Figure 2
Figure 2
Effectiveness of treatments when using standardised continuous outcome measures. References to studies can be found on bmj.com
Figure 3
Figure 3
Effectiveness of treatment when using clinical global impression (improvement) scale. References to studies can be found on bmj.com
Figure 4
Figure 4
Number of patients withdrawing from treatment for any reason
Figure 5
Figure 5
Number of patients withdrawing from treatment due to side effects
See this image and copyright information in PMC

Comment in

References

    1. Katon W, Schulberg H. Epidemiology of depression in primary care. Gen Hosp Psychiatry. 1992;14:237–247. - PubMed
    1. Suh T, Gallo JJ. The management of depression among general medical service providers. Psychol Med. 1999;27:1051–1063. - PubMed
    1. Arya R. The management of depression in primary health care. Curr Opin. 1999;12:103–107.
    1. Gill D. Prescribing antidepressants in general practice. Systematic review of all pertinent trials is required to establish guidelines. BMJ. 1997;314:826–827. - PMC - PubMed
    1. Williams JW, Jr, Mulrow CD, Chiquette E, Noel PH, Aguilar C, Cornell J. A systematic review of newer pharmacotherapies for depression in adults: evidence report summary. Ann Intern Med. 2000;132:743–756. - PubMed

MeSH terms

Substances