Axis I psychiatric disorders such as depressive disorder, anxiety disorder, adjustment disorder, and premenstrual disorders are serious disabling illnesses. Newer treatments for these disorders include selective serotonin reuptake inhibitors (SSRIs), serotonin and norepinephrine reuptake inhibitors (SNRIs), and other second-generation drugs. The purpose of this review is to help policymakers and clinicians make informed choices about the use of SSRIs and newer antidepressants.

Contents

• Introduction
  • Overview
  • Scope and Key Questions
• Methods
  • Literature Search
  • Study Selection
  • Data Abstraction
  • Quality Assessment
  • Data Synthesis
• Results
  • Overview
  • Key Question 1: Efficacy
  • Key Question 2: Safety
  • Key Question 3: Subgroups
  • Exhibit 1: Meta-analysis of studies comparing fluoxetine to paroxetine
  • Exhibit 2: Meta-analysis of studies comparing fluoxetine to sertraline
  • Exbihit 3: Meta-analysis of studies comparing venlafaxine to fluoxetine
  • Exhibit 4: Meta-analyses of discontinuation rates
• References
• Appendixes
  • Appendix A. Search Strategy
  • Appendix B. Quality assessment methods for drug class reviews for the Drug Effectiveness Review Project
  • Appendix C. Characteristics of excluded studies
  • Appendix D. Pharmacokinetic properties and drug interactions
  • Appendix E. Placebo-controlled trials of second generation antidepressants (not included)
  • Appendix F. Abstract-only studies (not included)
  • Appendix G: Acknowledgements
• Evidence Tables

Oregon Evidence-based Practice Center, Oregon Health & Science University, Mark Helfand, MD, MPH, Director

The funding source, the Center for Evidence-based Policy, is supported by 17 organizations, including 15 state Medicaid programs. These organizations selected the topic and had input into the Key Questions for this review. The content and conclusions of the review are entirely determined by the Evidence-based Practice Center researchers. The authors of this report have no financial interest in any company that makes or distributes the products reviewed in this report.

Suggested citation:

Gartlehner, Gerald M.D., M.P.H., Hansen, Richard A. Ph.D., Kahwati, Leila M.D., M.P.H. Drug Class Review on Second Generation Antidepressants. 2006. http://derp.ohsu.edu/about/final-products.cfm

The purpose of this report is to make available information regarding the comparative effectiveness and safety profiles of different drugs within pharmaceutical classes. Reports are not usage guidelines, nor should they be read as an endorsement of, or recommendation for, any particular drug, use or approach. Oregon Health & Science University does not recommend or endorse any guideline or recommendation developed by users of these reports.