title: Comparative efficacy and safety of selective serotonin reuptake inhibitors and serotonin-norepinephrine reuptake inhibitors in older adults: a network meta-analysis.
abstract: OBJECTIVE
  To establish the comparative efficacy and safety of selective serotonin reuptake inhibitors and serotonin-norepinephrine reuptake inhibitors in older adults using the network meta-analysis approach.
  
  
  METHODS
  Systematic review and network meta-analysis.
  
  
  METHODS
  Individuals aged 60 and older.
  
  
  METHODS
  Data on partial response (defined as at least 50% reduction in depression score from baseline) and safety (dizziness, vertigo, syncope, falls, loss of consciousness) were extracted. A Bayesian network meta-analysis was performed on the efficacy and safety outcomes, and relative risks (RRs) with 95% credible intervals (CrIs) were produced.
  
  
  RESULTS
  Fifteen randomized controlled trials were eligible for inclusion in the analysis. Citalopram, escitalopram, paroxetine, duloxetine, venlafaxine, fluoxetine, and sertraline were represented. Reporting on partial response and dizziness was sufficient to conduct a network meta-analysis. Reporting on other outcomes was sparse. For partial response, sertraline (RR=1.28), paroxetine (RR=1.48), and duloxetine (RR=1.62) were significantly better than placebo. The remaining interventions yielded RRs lower than 1.20. For dizziness, duloxetine (RR=3.18) and venlafaxine (RR=2.94) were statistically significantly worse than placebo. Compared with placebo, sertraline had the lowest RR for dizziness (1.14) and fluoxetine the second lowest (1.31). Citalopram, escitalopram, and paroxetine all had RRs between 1.4 and 1.7.
  
  
  CONCLUSIONS
  There was clear evidence of the effectiveness of sertraline, paroxetine, and duloxetine. There also appears to be a hierarchy of safety associated with the different antidepressants, although there appears to be a dearth of reporting of safety outcomes.
authors.affiliation: Stanford Prevention Research Center, Stanford University, Stanford, California.|Department of Clinical Epidemiology and Biostatistics, McMaster University, Hamilton, Ontario, Canada.|Redwood Outcomes, Vancouver, British Columbia, Canada.
authors.forename: Kristian
authors.initials: K
authors.lastname: Thorlund
authors.affiliation: Redwood Outcomes, Vancouver, British Columbia, Canada.|Department of Medicine, University of British Columbia, Vancouver, British Columbia, Canada.
authors.forename: Eric
authors.initials: E
authors.lastname: Druyts
authors.affiliation: Redwood Outcomes, Vancouver, British Columbia, Canada.
authors.forename: Ping
authors.initials: P
authors.lastname: Wu
authors.affiliation: Redwood Outcomes, Vancouver, British Columbia, Canada.
authors.forename: Chakrapani
authors.initials: C
authors.lastname: Balijepalli
authors.affiliation: Pfizer Inc., New York, New York.
authors.forename: Denis
authors.initials: D
authors.lastname: Keohane
authors.affiliation: Stanford Prevention Research Center, Stanford University, Stanford, California.|Redwood Outcomes, Vancouver, British Columbia, Canada.
authors.forename: Edward
authors.initials: E
authors.lastname: Mills
mesh_terms: D018759:Adrenergic Uptake Inhibitors / Q000009:adverse effects / Q000627:therapeutic use*; D000368:Aged; D003865:Major Depressive Disorder / Q000188:drug therapy*; D006801:Humans; D016032:Randomized Controlled Trials as Topic; D017367:Selective Serotonin Reuptake Inhibitors / Q000009:adverse effects / Q000627:therapeutic use*; D016896:Treatment Outcome
chemical_list: D018759:Adrenergic Uptake Inhibitors; D017367:Selective Serotonin Reuptake Inhibitors
keywords: antidepressants; comparative efficacy; comparative safety; network meta-analysis; older adults