Cited by 941Treatment of Major DepressionAnxiety, Depression, Psychometrics, Treatment, Cognitive ProcessesPsychotherapy Techniques and Applications

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Selective serotonin reuptake inhibitors versus tricyclic antidepressants: a meta-analysis of efficacy and tolerability

Anderson, Ian M.·2000·Journal of Affective Disorders

DOI 10.1016/s0165-0327(99)00092-0

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Abstract

Background A meta-analysis of the efficacy and tolerability of selective serotonin reuptake inhibitors (SSRIs) against tricyclic antidepressants (TCAs) in depressed patients was carried out. Methods Efficacy data from 102 randomised controlled trials (10706 patients) were pooled to provide a summary variance-weighted effect size. Tolerability data from 95 studies (10553 patients) were combined to give variance-weighted relative risk of drop out for all reasons and for adverse effects from each study. The effect of age, treatment setting, severity and TCA dose were examined as well as the performance of individual SSRIs and TCAs where there were sufficient studies. Results There is no overall difference in efficacy between SSRIs and TCAs (effect size -0.03, 95% confidence interval -0.09 to 0.03). TCAs do appear more effective in in-patients (-0.23, -0.40 to -0.05) and amitriptyline is more effective than SSRI comparators (-0.14, -0.25 to -0.03) but publication bias cannot be excluded. The SSRIs are better tolerated, with significantly lower rates of treatment discontinuations overall (relative risk 0.88, 0.83 to 0.93; number needed to treat 26) and due to side effects (0.73, 0.67 to 0.80; number needed to treat 33). Individual SSRIs show a similar advantage except for fluvoxamine which does not differ from the TCAs. Individual TCAs show a similar disadvantage in tolerability compared to SSRIs except for dothiepin against which SSRI treatment results in more side-effect related…

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Authors: Anderson, I. M.
Affiliations: University of Manchester (GB)
Corresponding author: Anderson, Ian M.
ORCID: Anderson, Ian M.
Venue: Journal of Affective Disorders
Publisher: Elsevier BV
Published: 2000-04
Volume: 58
Issue: 1
Pages: 19-36
ISSN: 0165-0327 (ISSN-L)
DOI: 10.1016/s0165-0327(99)00092-0
OpenAlex: W2101963851
Cited by: 940
References: 159
Citations by year: 2026: 9 · 2025: 11 · 2024: 29 · 2023: 22 · 2022: 19 · 2021: 13 · 2020: 175 · 2019: 18 · 2018: 26 · 2017: 34 · 2016: 23 · 2015: 35 · 2014: 44 · 2013: 36 · 2012: 52
FWCI: 4.28
Type: journal article
Language: en
Open access: closed
Licence: www.elsevier.com/tdm/userlicense/1.0/ (tdm)
Locations: Journal of Affective Disorders (publishedVersion)
PubMed (publishedVersion)
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, tricyclic antidepressants, depression, antidepressant efficacy, antidepressant tolerability, treatment discontinuation, adverse drug reactions, amitriptyline, fluvoxamine, dothiepin, inpatient care, publication bias
MeSH terms: Antidepressive Agents, Tricyclic, Depressive Disorder, Humans, Randomized Controlled Trials as Topic, Treatment Outcome, Selective Serotonin Reuptake Inhibitors, Antidepressive Agents, Second-Generation

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Selective serotonin reuptake inhibitors versus tricyclic antidepressants: a meta-analysis of efficacy and tolerability

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