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Comparative Benefits and Harms of Second-Generation Antidepressants for Treating Major Depressive Disorder: An Updated Meta-analysis
Abstract
BACKGROUND: Second-generation antidepressants dominate the management of major depressive disorder (MDD), but evidence on the comparative benefits and harms of these agents is contradictory. PURPOSE: To compare the benefits and harms of second-generation antidepressants for treating MDD in adults. DATA SOURCES: English-language studies from PubMed, Embase, the Cochrane Library, PsycINFO, and International Pharmaceutical Abstracts from 1980 to August 2011 and reference lists of pertinent review articles and gray literature. STUDY SELECTION: 2 independent reviewers identified randomized trials of at least 6 weeks' duration to evaluate efficacy and observational studies with at least 1000 participants to assess harm. DATA EXTRACTION: Reviewers abstracted data about study design and conduct, participants, and interventions and outcomes and rated study quality. A senior reviewer checked and confirmed extracted data and quality ratings. DATA SYNTHESIS: Meta-analyses and mixed-treatment comparisons of response to treatment and weighted mean differences were conducted on specific scales to rate depression. On the basis of 234 studies, no clinically relevant differences in efficacy or effectiveness were detected for the treatment of acute, continuation, and maintenance phases of MDD. No differences in efficacy were seen in patients with accompanying symptoms or in subgroups based on age, sex, ethnicity, or comorbid conditions. Individual drugs differed in onset of action, adverse events, and some measures of health-related quality of life. LIMITATIONS: Most trials were conducted in highly selected populations. Publication bias might affect the estimates of some comparisons. Mixed-treatment comparisons cannot conclusively exclude differences in efficacy. Evidence within subgroups was limited. CONCLUSION: Current evidence does not warrant recommending a particular second-generation antidepressant on the basis of differences in efficacy. Differences in onset of action and adverse events may be considered when choosing a medication. PRIMARY FUNDING SOURCE: Agency for Healthcare Research and Quality.
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“Effective treatments for depression and anxiety exist in general and medical populations (van Straten et al., 2010; Gartlehner et al., 2011; Roshanaei-Moghaddam et al., 2011; Cuijpers et al., 2013, 2014; Hunsley et al., 2014; Bandelow et al., 2015”
From Systematic review and meta-analysis of interventions for depression and anxiety in persons with multiple sclerosis (2016) · cites this paper as Gartlehner et al., 2011
In the citing paper
“A recent comparative-effectiveness review found that secondgeneration antidepressants do not substantially differ from each other in terms of efficacy (17).”
From Risk of Dementia Among Elderly Nursing Home Patients Using Paroxetine and Other Selective Serotonin Reuptake Inhibitors (2015) · cites this paper as [17]
In the citing paper
“However many of these drugs can acutely induce adverse side effects including anxiety and increased risk of suicidal behaviors (Ferguson, 2001; Gartlehner et al., 2011; Vaswani et al., 2003).”
From Molecular and anatomical organization of the dorsal raphe nucleus (2019) · cites this paper as Gartlehner et al., 2011
In the citing paper
“Despite the controversy, antidepressant induced sexual dysfunction is an important concern because up to 80% of depressed patients from randomized clinical trials reported treatment-emergent sexual side effects.64”
From Addressing the Side Effects of Contemporary Antidepressant Drugs: A Comprehensive Review (2018) · cites this paper as [64]
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Metadata
- Authors
- Gartlehner, G., Hansen, R. A., Morgan, L. C., Thaler, K., Lux, L., Van Noord, M., Mager, U., Thieda, P., Gaynes, B. N., Wilkins, T., Strobelberger, M., Lloyd, S., Reichenpfader, U., & Lohr, K. N.
- Affiliations
- University of North Carolina at Chapel Hill (US)
- From Danube University, Krems, Austria; Auburn University, Auburn, Alabama; RTI International, Research Triangle Park, North Carolina; the University of North Carolina at Chapel Hill, Chapel Hill, North Carolina; and the Ludwig Boltzmann Institute for Health Promotion Research, Vienna, Austria.
- ORCID
- Venue
- Annals of Internal Medicine
- Publisher
- American College of Physicians
- Published
- 2011-12-06
- Volume
- 155
- Issue
- 11
- Pages
- 772-785
- ISSN
- 0003-4819 (ISSN-L)
- 1539-3704
- OpenAlex
- W2082270426
- Cited by
- 355
- References
- 131
- Citations by year
- 2026: 13 · 2025: 17 · 2024: 15 · 2023: 22 · 2022: 23 · 2021: 13 · 2020: 23 · 2019: 20 · 2018: 34 · 2017: 20 · 2016: 35 · 2015: 32 · 2014: 36 · 2013: 29 · 2012: 23
- FWCI
- 3.51
- Type
- journal article
- Language
- en
- Open access
- closed
- Locations
- Annals of Internal Medicine (publishedVersion)
- PubMed (publishedVersion)
- Annals of Internal Medicine
- Funders
- U.S. Public Health Service (290200710056I#2)
- Topics
- Health Sciences › Medicine › Pharmacology (medical) › Treatment of Major Depression
- Health Sciences › Medicine › Psychiatry and Mental health › Mental Health Treatment and Access
- Social Sciences › Psychology › Clinical Psychology › Psychotherapy Techniques and Applications
- Keywords
- second-generation antidepressants, major depressive disorder, antidepressant efficacy, antidepressant side effects, onset of action, health-related quality of life, maintenance therapy, continuation treatment, acute treatment
- MeSH terms
- Delayed-Action Preparations, Major Depressive Disorder, Humans, Recurrence, Remission Induction, Sexual Dysfunction, Physiological, Treatment Outcome, Antidepressive Agents, Second-Generation, Comparative Effectiveness Research, Suicidal Ideation
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