Most Tolerable Antidepressant May Not be Most Efficacious
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When it comes to antidepressants, popularity may translate into tolerability more than efficacy, suggests a systematic review of clinical trials by the Cochrane Collaboration. Consider Prozac (fluoxetine), for instance.
According to the Cochrane analysis, Zoloft (sertraline) and Effexor (venlafaxine) may be somewhat better than more popular Prozac for treating depression, reported Andrea Cipriani, M.D., of the University of Verona, and colleagues. However, patients seemed to tolerate Prozac better than other antidepressants.
Dr. Cipriani and colleagues stopped short of making any specific clinical recommendations based on their review, which was published in the current issue of The Cochrane Library.
The review pooled data from 132 published randomized controlled trials of selective serotonin uptake inhibitors (SSRIs) and other antidepressants. It included effectiveness data on more than 9,000 participants and tolerability data on more than 14,000. Results were presented in Peto Odds Ratios or Standardized Mean Differences.
Prozac was better tolerated than any other antidepressant, most notably Elavil or Endep (amitriptyline) OR=0.64; 95% CI=0.47-0.85 and Tofranil (imipramine) OR=0.79; 95% CI=0.63-0.99.
Antidepressants more effective than Prozac for treating depression: Prothiaden (dothiepin) OR=2.09; 95% confidence interval=1.08-4.05, Remeron (mirtazapine) OR=1.64; 95% CI=1.01-2.65, Zoloft OR=1.40; 95% CI=1.11-1.76, and Effexor: OR=1.40; 95% CI=1.15-1.70
Those appearing less effective than Prozac were ABT-200 (pyrrolidine methanesulfonate) Standardized Mean Difference = -1.85; 95% CI= -2.25 to -1.15, and Ixel (milnacipran): SMD= -0.38; 95% CI= -0.71 to -0.06.
“There are statistically significant differences in terms of efficacy and tolerability between fluoxetine and certain other antidepressants, but the clinical meaning of these differences is uncertain, and no definitive implications for clinical practice can be drawn,” the researchers said.
Until more evidence is available, treatment decisions should be based on considerations of clinical history, drug toxicity, patient acceptability, and cost, they concluded.
Source: The Cochrane Library
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