title: Paroxetine versus placebo and other agents for depressive disorders: a systematic review and meta-analysis.
abstract: OBJECTIVE
  To compare paroxetine with placebo and other antidepressants across multiple efficacy and tolerability outcomes.
  
  
  METHODS
  Searches were conducted in MEDLINE (1966-2004), EMBASE (1980-2004), CINAHL (1982-2004), all Evidence-Based Medicine Reviews (1991-2004), HealthSTAR (1975-2004), BIOSIS (1980-2004), and PsycINFO (1840-2004). Medical Subject Headings (MeSH) included "paroxetine" OR "Paxil" exploded. The searches were not restricted by language, publication type, or study design.
  
  
  METHODS
  A study report was included if it described a randomized trial of paroxetine versus placebo or other antidepressants for patients with depressive disorders. Records were screened independently by 2 reviewers under the supervision of another reviewer.
  
  
  METHODS
  Three investigators abstracted data, including study design, trial characteristics, and psychiatric assessment tools, using a prespecified form. Two investigators assessed quality of reporting using Jadad's scale.
  
  
  RESULTS
  We included 62 unique randomized controlled trials. Paroxetine yielded consistently and significantly better remission (rate difference [RD]: 10% [95% CI = 6 to 14]), clinical response (RD: 17% [95% CI = 7 to 27]), and symptom reduction (effect size: 0.2 [95% CI = 0.1 to 0.3]) than placebo. Such consistency in the evidence base was not observed between paroxetine and other antidepressants. Pairwise comparisons of paroxetine and venlafaxine, mirtazapine, mianserin, or fluoxetine yielded inconsistent results across efficacy outcomes. Controlled-release paroxetine was the only antidepressant with significantly fewer dropouts due to adverse events than immediate-release paroxetine (RD: 5% [95% CI = 0.1 to 11]).
  
  
  CONCLUSIONS
  There were no significant and valid differences between paroxetine and other antidepressants to suggest that multiple modes of action improve clinical outcomes.
authors.affiliation: Faculty of Medicine, Department of Psychiatry, University of Toronto, Ontario, Canada. mkatzman@startclinic.ca
authors.forename: Martin A
authors.initials: MA
authors.lastname: Katzman
authors.forename: Andrea C
authors.initials: AC
authors.lastname: Tricco
authors.forename: Diane
authors.initials: D
authors.lastname: McIntosh
authors.forename: Marie J
authors.initials: MJ
authors.lastname: Filteau
authors.forename: Pierre
authors.initials: P
authors.lastname: Bleau
authors.forename: Pratap R
authors.initials: PR
authors.lastname: Chokka
authors.forename: Kevin D
authors.initials: KD
authors.lastname: Kjernisted
authors.forename: Hiram
authors.initials: H
authors.lastname: Mok
authors.forename: Ba'
authors.initials: B
authors.lastname: Pham
mesh_terms: D000328:Adult; D000368:Aged; D000369:Aged, 80 and over; D000928:Antidepressive Agents / Q000627:therapeutic use*; D003866:Depressive Disorder / Q000188:drug therapy*; D005260:Female; D006801:Humans; D008297:Male; D008875:Middle Aged; D017374:Paroxetine / Q000627:therapeutic use*; D010919:Placebos; D016032:Randomized Controlled Trials as Topic; D017367:Selective Serotonin Reuptake Inhibitors / Q000627:therapeutic use*; D016896:Treatment Outcome
chemical_list: D000928:Antidepressive Agents; D017374:Paroxetine; D010919:Placebos; D017367:Selective Serotonin Reuptake Inhibitors