Comparative benefits and harms of second-generation antidepressants for treating major depressive disorder: An updated meta-analysis

Gerald Gartlehner, Richard A. Hansen, Laura C. Morgan, Kylie Thaler, Linda Lux, Megan van Noord, Ursula Mager, Patricia Thieda, Bradley N. Gaynes, Tania Wilkins, Michaela Strobelberger, Stacey Lloyd, Ursula Reichenpfader, Kathleen N. Lohr

Research output: Contribution to journalReview article

202 Citations (Scopus)

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 healthrelated 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.

Original languageEnglish (US)
Pages (from-to)772-785
Number of pages14
JournalAnnals of internal medicine
Volume155
Issue number11
DOIs
StatePublished - Jan 1 2011
Externally publishedYes

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Major Depressive Disorder
Antidepressive Agents
Meta-Analysis
Publication Bias
Information Storage and Retrieval
Health Services Research
PubMed
Pharmaceutical Preparations
Libraries
Observational Studies
Language
Therapeutics
Maintenance
Quality of Life
Outcome Assessment (Health Care)
Depression
Population

ASJC Scopus subject areas

  • Internal Medicine

Cite this

Comparative benefits and harms of second-generation antidepressants for treating major depressive disorder : An updated meta-analysis. / Gartlehner, Gerald; Hansen, Richard A.; Morgan, Laura C.; Thaler, Kylie; Lux, Linda; van Noord, Megan; Mager, Ursula; Thieda, Patricia; Gaynes, Bradley N.; Wilkins, Tania; Strobelberger, Michaela; Lloyd, Stacey; Reichenpfader, Ursula; Lohr, Kathleen N.

In: Annals of internal medicine, Vol. 155, No. 11, 01.01.2011, p. 772-785.

Research output: Contribution to journalReview article

Gartlehner, G, Hansen, RA, Morgan, LC, Thaler, K, Lux, L, van Noord, M, Mager, U, Thieda, P, Gaynes, BN, Wilkins, T, Strobelberger, M, Lloyd, S, Reichenpfader, U & Lohr, KN 2011, 'Comparative benefits and harms of second-generation antidepressants for treating major depressive disorder: An updated meta-analysis', Annals of internal medicine, vol. 155, no. 11, pp. 772-785. https://doi.org/10.7326/0003-4819-155-11-201112060-00009
Gartlehner, Gerald ; Hansen, Richard A. ; Morgan, Laura C. ; Thaler, Kylie ; Lux, Linda ; van Noord, Megan ; Mager, Ursula ; Thieda, Patricia ; Gaynes, Bradley N. ; Wilkins, Tania ; Strobelberger, Michaela ; Lloyd, Stacey ; Reichenpfader, Ursula ; Lohr, Kathleen N. / Comparative benefits and harms of second-generation antidepressants for treating major depressive disorder : An updated meta-analysis. In: Annals of internal medicine. 2011 ; Vol. 155, No. 11. pp. 772-785.
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T2 - An updated meta-analysis

AU - Gartlehner, Gerald

AU - Hansen, Richard A.

AU - Morgan, Laura C.

AU - Thaler, Kylie

AU - Lux, Linda

AU - van Noord, Megan

AU - Mager, Ursula

AU - Thieda, Patricia

AU - Gaynes, Bradley N.

AU - Wilkins, Tania

AU - Strobelberger, Michaela

AU - Lloyd, Stacey

AU - Reichenpfader, Ursula

AU - Lohr, Kathleen N.

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N2 - 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 healthrelated 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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