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Cited by 79Treatment of Major DepressionAnxiety, Depression, Psychometrics, Treatment, Cognitive ProcessesMental Health Treatment and Access

Comparative Efficacy and Safety of Selective Serotonin Reuptake Inhibitors and Serotonin‐Norepinephrine Reuptake Inhibitors in Older Adults: A Network Meta‐Analysis

Thorlund, Kristian, Druyts, Eric, Wu, Ping, Balijepalli, Chakrapani, Keohane, Denis, Mills, Edward·2015·Journal of the American Geriatrics Society
DOI 10.1111/jgs.13395
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Abstract

Objectives: 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. Design: Systematic review and network meta‐analysis. Participants: Individuals aged 60 and older. Measurements: 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 ( RR s) 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 RR s 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 RR s between 1.4 and 1.7. Conclusion: 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.

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Authors
Thorlund, K., Druyts, E., Wu, P., Balijepalli, C., Keohane, D., & Mills, E.
Affiliations
  • Stanford University (US)
  • University of British Columbia (CA)
  • Redwood Outcomes Vancouver British Columbia Canada
  • Pfizer (United States) (US)
Corresponding author
Mills, Edward
ORCID
Venue
Journal of the American Geriatrics Society
Publisher
Wiley
Published
2015-05
Volume
63
Issue
5
Pages
1002-1009
ISSN
  • 0002-8614 (ISSN-L)
  • 1532-5415
DOI
10.1111/jgs.13395
OpenAlex
W1524088676
Semantic Scholar
6986b43d32b94ae1dfb294cfc1fade2b25fa5fbf
Cited by
79
References
64
Citations by year
2026: 2 · 2025: 3 · 2024: 7 · 2023: 6 · 2022: 5 · 2021: 9 · 2020: 8 · 2019: 9 · 2018: 6 · 2017: 10 · 2016: 10 · 2015: 3
FWCI
6.97
Type
journal article
Language
en
Open access
closed
Licence
onlinelibrary.wiley.com/termsAndConditions#vor (vor, 5 d)
Locations
  • Journal of the American Geriatrics Society (publishedVersion)
  • PubMed (publishedVersion)
Funders
  • Canadian Institutes of Health Research Drug Safety & Effectiveness Network
  • Pfizer Inc
Topics
  • Health Sciences › Medicine › Pharmacology › Treatment of Major Depression
  • Social Sciences › Psychology › Experimental and Cognitive Psychology › Anxiety, Depression, Psychometrics, Treatment, Cognitive Processes
  • Social Sciences › Psychology › Social Psychology › Mental Health Treatment and Access
Keywords
selective serotonin reuptake inhibitors, serotonin-norepinephrine reuptake inhibitors, geriatric depression, antidepressant efficacy, antidepressant safety, dizziness, falls, sertraline, paroxetine, duloxetine, venlafaxine, fluoxetine, citalopram, escitalopram, partial response
MeSH terms
Aged, Major Depressive Disorder, Depressive Disorder, Major, Humans, Randomized Controlled Trials as Topic, Treatment Outcome, Selective Serotonin Reuptake Inhibitors, Adrenergic Uptake Inhibitors

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