Sertraline versus other antidepressive agents for depression.
BACKGROUND
The National Institute for Health and Clinical Excellence clinical practice guideline on the treatment of depressive disorder recommended that selective serotonin reuptake inhibitors should be the first-line option when drug therapy is indicated for a depressive episode. Preliminary evidence suggested that sertraline might be slightly superior in terms of effectiveness.


OBJECTIVE
To assess the evidence for the efficacy, acceptability and tolerability of sertraline in comparison with tricyclics (TCAs), heterocyclics, other SSRIs and newer agents in the acute-phase treatment of major depression.


METHODS
MEDLINE (1966 to 2008), EMBASE (1974 to 2008), the Cochrane Collaboration Depression, Anxiety and Neurosis Controlled Trials Register and the Cochrane Central Register of Controlled Trials up to July 2008. No language restriction was applied. Reference lists of relevant papers and previous systematic reviews were hand-searched. Pharmaceutical companies and experts in this field were contacted for supplemental data.


METHODS
Randomised controlled trials allocating patients with major depression to sertraline versus any other antidepressive agent.


METHODS
Two review authors independently extracted data. Discrepancies were resolved with another member of the team. A double-entry procedure was employed by two reviewers. Information extracted included study characteristics, participant characteristics, intervention details and outcome measures in terms of efficacy (the number of patients who responded or remitted), acceptability (the number of patients who failed to complete the study) and tolerability (side-effects).


RESULTS
A total of 59 studies, mostly of low quality, were included in the review, involving multiple treatment comparisons between sertraline and other antidepressant agents. Evidence favouring sertraline over some other antidepressants for the acute phase treatment of major depression was found, either in terms of efficacy (fluoxetine) or acceptability/tolerability (amitriptyline, imipramine, paroxetine and mirtazapine). However, some differences favouring newer antidepressants in terms of efficacy (mirtazapine) and acceptability (bupropion) were also found. In terms of individual side effects, sertraline was generally associated with a higher rate of participants experiencing diarrhoea.


CONCLUSIONS
This systematic review and meta-analysis highlighted a trend in favour of sertraline over other antidepressive agents both in terms of efficacy and acceptability, using 95% confidence intervals and a conservative approach, with a random effects analysis. However, the included studies did not report on all the outcomes that were pre-specified in the protocol of this review. Outcomes of clear relevance to patients and clinicians were not reported in any of the included studies.
Cipriani
Andrea
A
Department of Medicine and Public Health, Section of Psychiatry and Clinical Psychology, University of Verona, Policlinico "G.B.Rossi", Piazzale L.A. Scuro, 10, Verona, Italy, 37134.
La Ferla
Teresa
T
Furukawa
Toshi A
TA
Signoretti
Alessandra
A
Nakagawa
Atsuo
A
Churchill
Rachel
R
McGuire
Hugh
H
Barbui
Corrado
C
D000928:Antidepressive Agents / Q000009:adverse effects / Q000627:therapeutic use*; D003863:Depression / Q000188:drug therapy*; D003967:Diarrhea / Q000139:chemically induced; D006801:Humans; D016032:Randomized Controlled Trials as Topic; D017367:Selective Serotonin Reuptake Inhibitors / Q000009:adverse effects / Q000627:therapeutic use*; D020280:Sertraline / Q000009:adverse effects / Q000627:therapeutic use*; D016896:Treatment Outcome
D000928:Antidepressive Agents; D017367:Selective Serotonin Reuptake Inhibitors; D020280:Sertraline
JAMA. 2002 Apr 10;287(14):1807-14
11939866
Cochrane Database Syst Rev. 2000;(4):CD002791
11034764
Int Clin Psychopharmacol. 1993 Fall;8(3):197-202
8263318
Eur Psychiatry. 1999 Mar;14(1):41-8
10572324
Am J Psychiatry. 2005 Oct;162(10):1957-60
16199844
J Clin Psychopharmacol. 2005 Oct;25(5):471-5
16160624
J Clin Psychiatry. 1997 Nov;58(11):484-91
9413414
Can J Psychiatry. 2004 Sep;49(9):601-6
15503731
Cochrane Database Syst Rev. 2010 Mar 17;(3):CD006114
20238342
CMAJ. 2004 Feb 17;170(4):477-80
14970094
Int Clin Psychopharmacol. 1997 Nov;12(6):323-31
9547134
Pharmacopsychiatry. 1998 Sep;31(5):170-7
9832348
Eur J Clin Pharmacol. 2004 Nov;60(9):629-34
15448956
Ann Clin Psychiatry. 1999 Dec;11(4):205-15
10596735
J Clin Psychiatry. 1990 Jun;51 Suppl:51-7; discussion 58-9
2189875
Cochrane Database Syst Rev. 2009 Jul 08;(3):CD006529
19588396
J Clin Psychiatry. 1990 Dec;51 Suppl B:18-27
2258378
Cochrane Database Syst Rev. 2007;(2):
25267891
Ann Pharmacother. 2004 Apr;38(4):579-85
14982982
Clin Ther. 2000 Apr;22(4):411-9
10823363
Arch Gen Psychiatry. 1962 Dec;7:407-17
13931376
Stat Med. 2002 Aug 30;21(16):2313-24
12210616
Curr Med Res Opin. 2007 Feb;23(2):245-50
17288677
Arch Gen Psychiatry. 1991 Apr;48(4):319-23
2009033
Int J Epidemiol. 2002 Feb;31(1):72-6
11914297
Neuropsychopharmacology. 2003 Mar;28(3):552-7
12629536
J Clin Epidemiol. 2006 Nov;59(11):1125-6
17027421
Psychopharmacology (Berl). 2004 Oct;175(4):399-406
15042278
Int Psychogeriatr. 2001 Mar;13(1):75-84
11352337
Am J Psychiatry. 2000 May;157(5):729-36
10784465
J Clin Psychiatry. 1995 Jun;56(6):229-37
7775364
J Clin Psychopharmacol. 2000 Dec;20(6):645-52
11106136
J Clin Psychiatry. 1996;57 Suppl 2:53-62
8626364
Curr Med Res Opin. 2006 Sep;22(9):1703-13
16968574
Encephale. 2002 Jul-Aug;28(4):343-9
12232543
J Affect Disord. 2000 Apr;58(1):19-36
10760555
Pharmacopsychiatry. 2000 Nov;33(6):206-12
11147927
BMJ. 1999 May 1;318(7192):1180-4
10221945
JAMA. 2003 Aug 20;290(7):921-8
12928469
Cochrane Database Syst Rev. 2005 Oct 19;(4):CD004185
16235353
JAMA. 2002 Aug 14;288(6):701-9
12169073
Br J Psychiatry. 1979 Apr;134:382-9
444788
J Clin Epidemiol. 2006 Jan;59(1):7-10
16360555
J Clin Psychopharmacol. 2003 Aug;23(4):358-64
12920411
Pharmacopsychiatry. 2004 May;37(3):93-7
15179966
Ann Intern Med. 1992 Jan 1;116(1):78-84
1530753
J Clin Psychiatry. 1990 Dec;51 Suppl B:28-33
2258379
Prog Neuropsychopharmacol Biol Psychiatry. 2003 May;27(3):493-500
12691786
Turk Psikiyatri Derg. 2005 Fall;16(3):153-63
16180148
Acta Psychiatr Belg. 1995 May-Jun;95(3):139-51
8525856
JAMA. 2002 Apr 10;287(14):1853-4
11939872
Lancet. 2004 Apr 24;363(9418):1341-5
15110490
Cochrane Database Syst Rev. 2008 Oct 08;(4):CD000448
18843608
Pharmacopsychiatry. 2005 Mar;38(2):78-86
15744631
Br J Psychiatry. 2003 Aug;183:102-4
12893662
J Neurol Neurosurg Psychiatry. 1960 Feb;23:56-62
14399272
Stat Methods Med Res. 2008 Jun;17(3):279-301
17925316
Br J Psychiatry. 1999 Apr;174:297-303
10533547
J Pharmacol Exp Ther. 1983 Sep;226(3):686-700
6310078
Soc Sci Med. 1998 Jun;46(12):1569-85
9672396
Cochrane Database Syst Rev. 2007 Jul 18;(3):CD001851
17636689
J Affect Disord. 2000 Aug;59(2):119-26
10837880
BMJ. 1996 Nov 9;313(7066):1200
8916759
Ann Intern Med. 2000 May 2;132(9):743-56
10787370
J Clin Psychiatry. 2000 Dec;61(12):942-6
11206600
Pharmacoeconomics. 1998 Jan;13(1 Pt 2):157-69
10184835
World J Biol Psychiatry. 2002 Jan;3(1):5-43
12479086
J Gen Intern Med. 1999 Sep;14(9):569-80
10491249
CNS Drug Rev. 2001 Spring;7(1):1-24
11420570
J Clin Psychiatry. 2005 Mar;66(3):346-52
15766301
J Clin Psychiatry. 2000 Feb;61(2):95-100
10732656
N Engl J Med. 2007 Jun 7;356(23):2343-6
17485726
BMJ. 2003 May 31;326(7400):1167-70
12775614
J Clin Psychiatry. 2003 Aug;64(8):875-82
12927001
Aust N Z J Psychiatry. 2004 Jun;38(6):389-407
15209830
Int Clin Psychopharmacol. 2003 Jul;18(4):203-10
12817154
Cardiol Rev. 2006 Jul-Aug;14(4):164-9
16788327
J Clin Psychiatry. 2000 Aug;61(8):559-68
10982198
J Psychopharmacol. 1994 Jan;8(3):171-6
22298585
Int Clin Psychopharmacol. 2005 Jan;20(1):49-52
15602117
Int Clin Psychopharmacol. 1994 Summer;9(2):95-100
8057000
J Clin Psychiatry. 2006 Nov;67(11):1674-81
17196045
Control Clin Trials. 2004 Dec;25(6):598-612
15588746
J Clin Psychiatry. 2005 Oct;66(10):1312-20
16259546
Am J Psychiatry. 1996 Dec;153(12):1631-3
8942464
Biol Psychiatry. 2000 Nov 1;48(9):894-901
11074227
Int Clin Psychopharmacol. 2000 Sep;15(5):263-71
10993128
BMJ. 2004 Apr 17;328(7445):939-43
15087342
J Psychopharmacol. 1999 Dec;13(4):406-14
10667618
Psychopharmacol Bull. 1997;33(1):101-3
9133758
J Clin Psychopharmacol. 2002 Apr;22(2):137-47
11910258
JAMA. 2007 Jan 24;297(4):367-79
17244833
J Clin Psychiatry. 1988 Aug;49 Suppl:40-5
3045112
Clin Evid. 2004 Dec;(12):1391-436
15865725
J Affect Disord. 2000 Aug;59(2):149-57
10837883
BMJ. 2007 Feb 3;334(7587):215-6
17272528
J Clin Psychiatry. 1997 Dec;58(12):532-7
9448656
Lancet. 2009 Feb 28;373(9665):746-58
19185342
Br J Psychiatry. 2002 May;180:396-404
11983635
Clin Ther. 1999 Apr;21(4):643-58
10363731
Can Fam Physician. 2002 May;48:905-12
12053635
BMJ. 2002 Nov 2;325(7371):991
12411354
BMJ. 2003 Sep 6;327(7414):557-60
12958120
Cochrane Database Syst Rev. 2007;(2):
25267892