Outcome: Depression severity (measured with Hamilton Depression Rating Scale after 4 to 12 weeks)
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Studies
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Design
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Quality
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Consistency
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Directness
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SD
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SA
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RB
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DR
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PC
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8 trials Citalopram
38 trials Fluoxetine
25 trials Fluvoxamine
2 trials Nefazodone
18 trials Paroxetine
4 trials Sertaline
4 trials Velafaxine
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RCTs
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No serious limitations
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No important inconsistency
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Some uncertainty about directness (outcome measure)*
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No
|
No
|
No
|
No
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No
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Outcome: Transient side effects resulting in discontinuation of treatment
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8 trials Citalopram
50 trials Fluoxetine
27 trials Fluvoxamine
4 trials Nefazodone
23 trials Paroxetine
6 trials Sertaline
5 trials Velafaxine
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RCTs
|
No serious limitations
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No important inconsistency
|
Direct
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No
|
No
|
No
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No
|
No
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Outcome: Poisoning fatalities
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Office for National Statistics (British)
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Observational data
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Serious limitation**
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Only one study
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Direct
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No
|
++
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No
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No
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No
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- *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.