Comparative effectiveness of second-generation antidepressants for accompanying anxiety, insomnia, and pain in depressed patients: A systematic review

Kylie J. Thaler, Laura C. Morgan, Megan Van Noord, Bradley N. Gaynes, Richard A. Hansen, Linda J. Lux, Erin E. Krebs, Kathleen N. Lohr, Gerald Gartlehner

Research output: Contribution to journalReview article

40 Citations (Scopus)

Abstract

Background Patients with major depressive disorder (MDD) often suffer from accompanying symptoms that influence the choice of pharmacotherapy with second-generation antidepressants (SGAs). We conducted a systematic review to determine the comparative effectiveness of citalopram, escitalopram, fluoxetine, fluvoxamine, paroxetine, sertraline, desvenlafaxine, duloxetine, venlafaxine, bupropion, mirtazapine, nefazodone, and trazodone, for accompanying anxiety, insomnia, and pain in patients with MDD. Methods We conducted searches in multiple databases including MEDLINE®, Embase, the Cochrane Library, International Pharmaceutical Abstracts, and PsycINFO, from 1980 through August 2011 and reviewed reference lists of pertinent articles. We dually reviewed abstracts, full-text articles, and abstracted data. We included randomized, head-to-head trials of SGAs of at least 6 weeks' duration. We grouped SGAs into three classes for the analysis: selective serotonin reuptake inhibitors (SSRIs), serotonin norepinephrine reuptake inhibitors, and others. We graded the strength of the evidence as high, moderate, low, or very low based on the Grading of Recommendations Assessment, Development and Evaluation (GRADE) Working Group (GRADE) approach. Results We located 19 head-to-head trials in total: 11 on anxiety, six on insomnia, and four on pain. For the majority of comparisons, the strength of the evidence was moderate or low: evidence is weakened by inconsistency and imprecision. For treating anxiety, insomnia, and pain moderate evidence suggests that the SSRIs do not differ. Conclusions Evidence guiding the selection of an SGA based on accompanying symptoms of depression is limited. Very few trials were designed and adequately powered to answer questions about accompanying symptoms; analyses were generally of subgroups in larger MDD trials.

Original languageEnglish (US)
Pages (from-to)495-505
Number of pages11
JournalDepression and Anxiety
Volume29
Issue number6
DOIs
StatePublished - Jun 1 2012
Externally publishedYes

Fingerprint

Sleep Initiation and Maintenance Disorders
Antidepressive Agents
Major Depressive Disorder
Anxiety
Pain
Citalopram
Serotonin Uptake Inhibitors
Trazodone
Fluvoxamine
Bupropion
Sertraline
Paroxetine
Fluoxetine
MEDLINE
Libraries
Databases
Depression
Drug Therapy
Pharmaceutical Preparations

Keywords

  • antidepressants
  • anxiety/anxiety disorders
  • chronic pain
  • Clinical Trials
  • depression
  • treatment

ASJC Scopus subject areas

  • Clinical Psychology
  • Psychiatry and Mental health

Cite this

Comparative effectiveness of second-generation antidepressants for accompanying anxiety, insomnia, and pain in depressed patients : A systematic review. / Thaler, Kylie J.; Morgan, Laura C.; Van Noord, Megan; Gaynes, Bradley N.; Hansen, Richard A.; Lux, Linda J.; Krebs, Erin E.; Lohr, Kathleen N.; Gartlehner, Gerald.

In: Depression and Anxiety, Vol. 29, No. 6, 01.06.2012, p. 495-505.

Research output: Contribution to journalReview article

Thaler, Kylie J. ; Morgan, Laura C. ; Van Noord, Megan ; Gaynes, Bradley N. ; Hansen, Richard A. ; Lux, Linda J. ; Krebs, Erin E. ; Lohr, Kathleen N. ; Gartlehner, Gerald. / Comparative effectiveness of second-generation antidepressants for accompanying anxiety, insomnia, and pain in depressed patients : A systematic review. In: Depression and Anxiety. 2012 ; Vol. 29, No. 6. pp. 495-505.
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AU - Morgan, Laura C.

AU - Van Noord, Megan

AU - Gaynes, Bradley N.

AU - Hansen, Richard A.

AU - Lux, Linda J.

AU - Krebs, Erin E.

AU - Lohr, Kathleen N.

AU - Gartlehner, Gerald

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N2 - Background Patients with major depressive disorder (MDD) often suffer from accompanying symptoms that influence the choice of pharmacotherapy with second-generation antidepressants (SGAs). We conducted a systematic review to determine the comparative effectiveness of citalopram, escitalopram, fluoxetine, fluvoxamine, paroxetine, sertraline, desvenlafaxine, duloxetine, venlafaxine, bupropion, mirtazapine, nefazodone, and trazodone, for accompanying anxiety, insomnia, and pain in patients with MDD. Methods We conducted searches in multiple databases including MEDLINE®, Embase, the Cochrane Library, International Pharmaceutical Abstracts, and PsycINFO, from 1980 through August 2011 and reviewed reference lists of pertinent articles. We dually reviewed abstracts, full-text articles, and abstracted data. We included randomized, head-to-head trials of SGAs of at least 6 weeks' duration. We grouped SGAs into three classes for the analysis: selective serotonin reuptake inhibitors (SSRIs), serotonin norepinephrine reuptake inhibitors, and others. We graded the strength of the evidence as high, moderate, low, or very low based on the Grading of Recommendations Assessment, Development and Evaluation (GRADE) Working Group (GRADE) approach. Results We located 19 head-to-head trials in total: 11 on anxiety, six on insomnia, and four on pain. For the majority of comparisons, the strength of the evidence was moderate or low: evidence is weakened by inconsistency and imprecision. For treating anxiety, insomnia, and pain moderate evidence suggests that the SSRIs do not differ. Conclusions Evidence guiding the selection of an SGA based on accompanying symptoms of depression is limited. Very few trials were designed and adequately powered to answer questions about accompanying symptoms; analyses were generally of subgroups in larger MDD trials.

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