There are no systematic reviews
of
depression treatment comparing antidepressants with placebo; hence,
we do not know whether these medications are
effective in primary care The Cochrane Collaboration Depression, Anxiety and
Neurosis Group register of controlled trials, MEDLINE, International
Pharmaceutical abstracts, PsycINFO, and EMBASE have been searched for corresponding abstracts.
abstracts of potential
studies were reviewed independently by 2 authors. Studies needed to
include randomized controlled trials of either a tricyclic
antidepressant (TCA) or selective serotonin reuptake inhibitor (SSRI),
or both, and placebo. The data and quality of
the studies were extracted by 2 independent authors. Disagreements were resolved by discussion. The main
outcome measures were the standardized mean difference and weighted
mean difference of the final mean depression scores, the
relative risk of improvement, and the number withdrawing because of side effects.
There
were 10 studies in which TCAs were
compared with placebo, 3 in which
SSRIs were compared with placebo, and 2 with both compared with
placebo. One half of the studies were of low methodological quality,
and nearly all studies were of short duration of 6 to 8 weeks.
Pooled estimates of efficacy data showed a relative risk of 1.26 for improvement with TCAs compared with placebo; For
SSRIs, relative risk was 1.37. Most patients, 56%
to 60%, responded well to active treatment compared with 42% to 47% for
placebo. Low-dose
(100 mg or 75 mg) TCAs were also effective. This systematic review is the first comparing antidepressants with
placebo for treatment of depression in primary care. Both TCAs and
SSRIs are effective. Prescribing
antidepressants is a more effective clinical activity
than prescribing placebo.
More summaries about the Efficacy and tolerability of tricyclic antidepressants and SSRIs compared with placebo