Cited by 407Treatment of Major DepressionAnxiety, Depression, Psychometrics, Treatment, Cognitive ProcessesPsychotherapy Techniques and Applications

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Early Onset of Selective Serotonin Reuptake Inhibitor Antidepressant Action: Systematic Review and Meta-analysis

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Taylor, Matthew J., Freemantle, Nick, Geddes, John R., Bhagwagar, Zubin·2006·Archives of General Psychiatry

DOI 10.1001/archpsyc.63.11.1217PMC PMC2211759

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Abstract

CONTEXT: Selective serotonin reuptake inhibitors (SSRIs) are often described as having a delayed onset of effect in the treatment of depression. However, some trials have reported clinical improvement as early as the first week of treatment. OBJECTIVE: To test the alternative hypotheses of delayed vs early onset of antidepressant action with SSRIs in patients with unipolar depression. DATA SOURCES: Trials identified by searching CENTRAL, The Cochrane Collaboration database of controlled trials (2005), and the reference lists of identified trials and other systematic reviews. STUDY SELECTION: Randomized controlled trials of SSRIs vs placebo for the treatment of unipolar depression in adults that reported outcomes for at least 2 time points in the first 4 weeks of treatment (50 trials from >500 citations identified). Trials were excluded if limited to participants older than 65 years or specific comorbidities. DATA EXTRACTION: Data were extracted on trial design, participant characteristics, and outcomes by a single reviewer. DATA SYNTHESIS: Pooled estimates of treatment effect on depressive symptom rating scales were calculated for weeks 1 through 6 of treatment. In the primary analysis, the pattern of response seen was tested against alternative models of onset of response. The primary analysis incorporated data from 28 randomized controlled trials (n=5872). A model of early treatment response best fit the experimental data. Treatment with SSRIs rather than placebo was associated with clinical improvement by the end of the first week of use. A secondary analysis indicated an increased chance of achieving a 50% reduction in Hamilton Depression Rating Scale scores by 1 week (relative risk, 1.64; 95% confidence interval, 1.2-2.25) with SSRI treatment compared with placebo. CONCLUSIONS: Treatment with SSRIs is associated with symptomatic improvement in depression by the end of the first week of use, and the improvement continues at a decreasing rate for at least 6 weeks.

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Authors: Taylor, M. J., Freemantle, N., Geddes, J. R., & Bhagwagar, Z.
Affiliations: Warneford Hospital (GB)
ORCID: Taylor, Matthew J.
Freemantle, Nick
Geddes, John R.
Bhagwagar, Zubin
Venue: Archives of General Psychiatry
Publisher: American Medical Association (AMA)
Published: 2006-11-01
Volume: 63
Issue: 11
Pages: 1217
ISSN: 0003-990X (ISSN-L)
DOI: 10.1001/archpsyc.63.11.1217
PMC: PMC2211759
OpenAlex: W2140505555
Cited by: 406
References: 62
Citations by year: 2026: 20 · 2025: 31 · 2024: 17 · 2023: 25 · 2022: 18 · 2021: 14 · 2020: 14 · 2019: 16 · 2018: 12 · 2017: 12 · 2016: 15 · 2015: 21 · 2014: 15 · 2013: 23 · 2012: 29
FWCI: 14.84
Type: journal article
Language: en
Open access: green
www.ncbi.nlm.nih.gov
Locations: Archives of General Psychiatry (publishedVersion)
PubMed (publishedVersion)
Europe PMC (PubMed Central) (acceptedVersion)
PubMed Central (acceptedVersion)
Research Portal (King's College London) (submittedVersion)
University of Birmingham Research Portal (University of Birmingham) (submittedVersion)
Funders: Wellcome Trust (075694)
Topics: Health Sciences › Medicine › Pharmacology (medical) › Treatment of Major Depression
Social Sciences › Psychology › Experimental and Cognitive Psychology › Anxiety, Depression, Psychometrics, Treatment, Cognitive Processes
Social Sciences › Psychology › Clinical Psychology › Psychotherapy Techniques and Applications
Keywords: selective serotonin reuptake inhibitors, antidepressant onset of action, major depressive disorder, early treatment response, placebo comparison, Hamilton Depression Rating Scale, antidepressant efficacy
MeSH terms: Adult, Age Factors, Depressive Disorder, Double-Blind Method, Humans, Middle Aged, Placebos, Psychiatric Status Rating Scales, Research Design, Risk, Time Factors, Confidence Intervals, Randomized Controlled Trials as Topic, Treatment Outcome, Selective Serotonin Reuptake Inhibitors

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Early Onset of Selective Serotonin Reuptake Inhibitor Antidepressant Action: Systematic Review and Meta-analysis

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