Author Topic: Similar Efficacy Among Second-Generation Antidepressants  (Read 1438 times)

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Similar Efficacy Among Second-Generation Antidepressants
« on: April 21, 2012, 05:59:33 PM »
Similar Efficacy Among Second-Generation Antidepressants

Monday, December 05, 2011

Filed under:  Mental Health | Pharmacy | Psychiatry
Second-generation antidepressants show no evidence of differences in efficacy for the treatment of major depressive disorder in adults, but differ according to onset of action and adverse events, according to a meta-analysis published in the Dec. 6 issue of the Annals of Internal Medicine.

(HealthDay News) — Second-generation antidepressants show no evidence of differences in efficacy for the treatment of major depressive disorder (MDD) in adults, but differ according to onset of action and adverse events, according to a meta-analysis published in the Dec. 6 issue of the Annals of Internal Medicine.

Gerald Gartlehner, M.D., M.P.H., from Danube University in Krems, Austria, and colleagues reviewed available literature from 1980 to August 2011 to compare the benefits and harms of second-generation antidepressants for treating MDD in adult patients. Data were extracted on study design and conduct, participants, and interventions and outcomes. Efficacy was evaluated in 234 randomized trials of at least six weeks, and harm was assessed in observational studies with at least 1,000 participants. Meta-analyses and mixed-treatment comparisons were performed to study the response to treatment, and weighted mean differences in the depression rate.

The investigators found that there were no clinically relevant differences in efficacy or effectiveness for the treatment of acute, continuation, and maintenance phases of MDD. Patients with accompanying symptoms, or patients sub-grouped on the basis of age, gender, ethnicity, or comorbid conditions, also showed no differences in efficacy. Each drug differed on the basis of onset of action, adverse events, and some measures of health-related quality of life.

"Current evidence does not warrant recommending a particular second-generation antidepressant on the basis of differences in efficacy. Differences in onset of action and adverse events may be considered when choosing a medication," the authors write.

One of the study authors disclosed financial ties to Novartis and Takeda Pharmaceutical Company.


Comparative Benefits and Harms of Second-Generation Antidepressants for Treating Major Depressive Disorder
An Updated Meta-analysis


   1. Gerald Gartlehner, MD, MPH;
   2. Richard A. Hansen, PhD, RPh;
   3. Laura C. Morgan, MA;
   4. Kylie Thaler, MD, MPH;
   5. Linda Lux, MPA;
   6. Megan Van Noord, MSIS;
   7. Ursula Mager, PhD, MPH;
   8. Patricia Thieda, MA;
   9. Bradley N. Gaynes, MD, MPH;
  10. Tania Wilkins, MSc;
  11. Michaela Strobelberger, MA;
  12. Stacey Lloyd, MPH;
  13. Ursula Reichenpfader, MD, MPH; and
  14. Kathleen N. Lohr, PhD

+ Author Affiliations

   1.
      From Danube University, Krems, Austria; Auburn University, Auburn, Alabama; RTI International, Research Triangle Park, North Carolina; the University of North Carolina at Chapel Hill, Chapel Hill, North Carolina; and the Ludwig Boltzmann Institute for Health Promotion Research, Vienna, Austria.

Abstract

Background: Second-generation antidepressants dominate the management of major depressive disorder (MDD), but evidence on the comparative benefits and harms of these agents is contradictory.

Purpose: To compare the benefits and harms of second-generation antidepressants for treating MDD in adults.

Data Sources: English-language studies from PubMed, Embase, the Cochrane Library, PsycINFO, and International Pharmaceutical Abstracts from 1980 to August 2011 and reference lists of pertinent review articles and gray literature.

Study Selection: 2 independent reviewers identified randomized trials of at least 6 weeks' duration to evaluate efficacy and observational studies with at least 1000 participants to assess harm.

Data Extraction: Reviewers abstracted data about study design and conduct, participants, and interventions and outcomes and rated study quality. A senior reviewer checked and confirmed extracted data and quality ratings.

Data Synthesis: Meta-analyses and mixed-treatment comparisons of response to treatment and weighted mean differences were conducted on specific scales to rate depression. On the basis of 234 studies, no clinically relevant differences in efficacy or effectiveness were detected for the treatment of acute, continuation, and maintenance phases of MDD. No differences in efficacy were seen in patients with accompanying symptoms or in subgroups based on age, sex, ethnicity, or comorbid conditions. Individual drugs differed in onset of action, adverse events, and some measures of health-related quality of life.

Limitations: Most trials were conducted in highly selected populations. Publication bias might affect the estimates of some comparisons. Mixed-treatment comparisons cannot conclusively exclude differences in efficacy. Evidence within subgroups was limited.

Conclusion: Current evidence does not warrant recommending a particular second-generation antidepressant on the basis of differences in efficacy. Differences in onset of action and adverse events may be considered when choosing a medication.

Primary Funding Source: Agency for Healthcare Research and Quality.