Outcome: Depression severity (measured with Hamilton Depression Rating Scale after 4 to 12 weeks) |
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Studies | Design | Quality | Consistency | Directness | SD | SA | RB | DR | PC |
8 trials Citalopram 38 trials Fluoxetine 25 trials Fluvoxamine 2 trials Nefazodone 18 trials Paroxetine 4 trials Sertaline 4 trials Velafaxine | RCTs | No serious limitations | No important inconsistency | Some uncertainty about directness (outcome measure)* | No | No | No | No | No |
Outcome: Transient side effects resulting in discontinuation of treatment
|
8 trials Citalopram 50 trials Fluoxetine 27 trials Fluvoxamine 4 trials Nefazodone 23 trials Paroxetine 6 trials Sertaline 5 trials Velafaxine | RCTs | No serious limitations | No important inconsistency | Direct | No | No | No | No | No |
Outcome: Poisoning fatalities
|
Office for National Statistics (British) | Observational data | Serious limitation** | Only one study | Direct | No | ++ | No | No | No |
- *There was uncertainty about the directness of the outcome measure because of the short duration of the trials.
- **It is possible that people at lower risk were more likely to have been given SSRI's and it is uncertain if changing antidepressant would have deterred suicide attempts.
- SD = Sparse data (Yes or No)
- SA = Strong association (No, + = strong, ++ = very strong)
- RB = Reporting bias (Yes or No)
- DR = Dose response (Yes or No)
- PC = All plausible confounders would have reduced the effect (Yes or No)
- CI = confidence interval
- WMD = weighted mean difference
- RRR = relative risk reduction
Question: Should depressed patients be treated with SSRIs rather than tricyclics?Setting: Primary carePatients: Moderately depressed adult patientsReference: North of England Evidence Based Guideline Development Project. Evidence based clinical practice guideline: the choice of antidepressants for depression in primary care. Newcastle upon Tyne: Centre for Health Services Research, 1997.