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, serotonin and norepinephrine reuptake inhibitors, and other second-generation drugs. The purpose of this review is to evaluate the comparative evidence on benefits and harms of these medications in people with depression to help policymakers and clinicians make informed choices about the use of selective serotonin reuptake inhibitors 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
  • Key Question 2
  • Key Question 3
• Addendum
  • Exhibit 1 Relative risk meta-analysis of response rates comparing citalopram to escitalopram
  • Exhibit 2 Effect size meta-analysis comparing citalopram to escitalopram on the MADRS
  • Exhibit 3 Meta-analysis of studies comparing fluoxetine to paroxetine
  • Exhibit 4 Meta-analysis of studies comparing fluoxetine to sertraline
  • Exhibit 5 Meta-analysis of studies comparing venlafaxine to fluoxetine
  • Exhibit 6 Meta-analyses of discontinuation rates
• References
• Appendixes
  • Appendix A. Search strategy
  • Appendix B. Methods for Drug Class Reviews for Oregon Health Plan Practitioner-Managed Prescription Drug Plan; Oregon Health and Science University Evidence-based Practice Center
  • Appendix C. Characteristics of excluded studies for poor quality
  • 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)
• Evidence Tables

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

The Drug Effectiveness Review Project, made up of 15 organizations including 14 state Medicaid agencies, commissioned and funded this report. These organizations selected the topic of the report and had input into its Key Questions. Content and conclusions of the report were determined entirely by researchers at the Evidence-based Practice Center. The authors of this report have no financial interest in any company that makes or distributes the products reviewed in the report.

Suggested citation:

Gartlehner G, Morgan LC, Thieda P, Thaler K, Hansen RA, Gaynes B, Lohr KN, Carey TS. Drug class review: Second generation antidepressants. Update 2. http://www.ohsu.edu/drugeffectiveness/reports/final.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.