title: Comparative benefits and harms of second-generation antidepressants for treating major depressive disorder: an updated meta-analysis.
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.
  
  
  OBJECTIVE
  To compare the benefits and harms of second-generation antidepressants for treating MDD in adults.
  
  
  METHODS
  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.
  
  
  METHODS
  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.
  
  
  METHODS
  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.
  
  
  RESULTS
  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.
  
  
  CONCLUSIONS
  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.
  
  
  CONCLUSIONS
  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.
  
  
  BACKGROUND
  Agency for Healthcare Research and Quality.
authors.affiliation: Danube University, Krems, Austria. gerald.gartlehner@donau-uni.ac.at
authors.forename: Gerald
authors.initials: G
authors.lastname: Gartlehner
authors.forename: Richard A
authors.initials: RA
authors.lastname: Hansen
authors.forename: Laura C
authors.initials: LC
authors.lastname: Morgan
authors.forename: Kylie
authors.initials: K
authors.lastname: Thaler
authors.forename: Linda
authors.initials: L
authors.lastname: Lux
authors.forename: Megan
authors.initials: M
authors.lastname: Van Noord
authors.forename: Ursula
authors.initials: U
authors.lastname: Mager
authors.forename: Patricia
authors.initials: P
authors.lastname: Thieda
authors.forename: Bradley N
authors.initials: BN
authors.lastname: Gaynes
authors.forename: Tania
authors.initials: T
authors.lastname: Wilkins
authors.forename: Michaela
authors.initials: M
authors.lastname: Strobelberger
authors.forename: Stacey
authors.initials: S
authors.lastname: Lloyd
authors.forename: Ursula
authors.initials: U
authors.lastname: Reichenpfader
authors.forename: Kathleen N
authors.initials: KN
authors.lastname: Lohr
mesh_terms: D018687:Antidepressive Agents, Second-Generation / Q000008:administration & dosage / Q000009:adverse effects* / Q000627:therapeutic use*; D057186:Comparative Effectiveness Research; D003692:Delayed-Action Preparations; D003865:Major Depressive Disorder / Q000150:complications / Q000188:drug therapy*; D006801:Humans; D012008:Recurrence; D012074:Remission Induction; D012735:Sexual Dysfunction, Physiological / Q000139:chemically induced; D059020:Suicidal Ideation; D016896:Treatment Outcome
chemical_list: D018687:Antidepressive Agents, Second-Generation; D003692:Delayed-Action Preparations