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Review
. 2010 Apr 14:(4):CD006117.
doi: 10.1002/14651858.CD006117.pub4.

Sertraline versus other antidepressive agents for depression

Andrea Cipriani  1 , Teresa La Ferla, Toshi A Furukawa, Alessandra Signoretti, Atsuo Nakagawa, Rachel Churchill, Hugh McGuire, Corrado Barbui
Affiliations
Review

Sertraline versus other antidepressive agents for depression

Andrea Cipriani et al. Cochrane Database Syst Rev. .

Abstract

Background: The National Institute for Health and Clinical Excellence clinical practice guideline on the treatment of depressive disorder recommended that selective serotonin reuptake inhibitors should be the first-line option when drug therapy is indicated for a depressive episode. Preliminary evidence suggested that sertraline might be slightly superior in terms of effectiveness.

Objectives: To assess the evidence for the efficacy, acceptability and tolerability of sertraline in comparison with tricyclics (TCAs), heterocyclics, other SSRIs and newer agents in the acute-phase treatment of major depression.

Search strategy: MEDLINE (1966 to 2008), EMBASE (1974 to 2008), the Cochrane Collaboration Depression, Anxiety and Neurosis Controlled Trials Register and the Cochrane Central Register of Controlled Trials up to July 2008. No language restriction was applied. Reference lists of relevant papers and previous systematic reviews were hand-searched. Pharmaceutical companies and experts in this field were contacted for supplemental data.

Selection criteria: Randomised controlled trials allocating patients with major depression to sertraline versus any other antidepressive agent.

Data collection and analysis: Two review authors independently extracted data. Discrepancies were resolved with another member of the team. A double-entry procedure was employed by two reviewers. Information extracted included study characteristics, participant characteristics, intervention details and outcome measures in terms of efficacy (the number of patients who responded or remitted), acceptability (the number of patients who failed to complete the study) and tolerability (side-effects).

Main results: A total of 59 studies, mostly of low quality, were included in the review, involving multiple treatment comparisons between sertraline and other antidepressant agents. Evidence favouring sertraline over some other antidepressants for the acute phase treatment of major depression was found, either in terms of efficacy (fluoxetine) or acceptability/tolerability (amitriptyline, imipramine, paroxetine and mirtazapine). However, some differences favouring newer antidepressants in terms of efficacy (mirtazapine) and acceptability (bupropion) were also found. In terms of individual side effects, sertraline was generally associated with a higher rate of participants experiencing diarrhoea.

Authors' conclusions: This systematic review and meta-analysis highlighted a trend in favour of sertraline over other antidepressive agents both in terms of efficacy and acceptability, using 95% confidence intervals and a conservative approach, with a random effects analysis. However, the included studies did not report on all the outcomes that were pre-specified in the protocol of this review. Outcomes of clear relevance to patients and clinicians were not reported in any of the included studies.

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Figures

Figure 1
Figure 1
Methodological quality graph: review authors’ judgements about each methodological quality item presented as percentages across all included studies.
Figure 2
Figure 2
Methodological quality summary: review authors’ judgements about each methodological quality item for each included study.
Figure 3
Figure 3
Forest plot of comparison: 1 Failure to respond at endpoint (6 - 12 weeks), outcome: 1.1 Sertraline versus TCAs.
Figure 4
Figure 4
Forest plot of comparison: 4 Failure to remission at endpoint (6 - 12 weeks), outcome: 4.1 Sertraline versus TCAs.
Figure 5
Figure 5
Forest plot of comparison: 7 Standardised mean difference at endpoint (6 - 12 weeks), outcome: 7.1 Sertraline versus TCAs.
Figure 6
Figure 6
Forest plot of comparison: 10 Failure to complete (any cause), outcome: 10.1 Sertraline versus TCAs.
Figure 7
Figure 7
Forest plot of comparison: 1 Failure to respond at endpoint (6 - 12 weeks), outcome: 1.2 Sertraline versus Heterocyclics.
Figure 8
Figure 8
Forest plot of comparison: 4 Failure to remission at endpoint (6 - 12 weeks), outcome: 4.2 Sertraline versus Heterocyclics.
Figure 9
Figure 9
Forest plot of comparison: 7 Standardised mean difference at endpoint (6 - 12 weeks), outcome: 7.2 Sertraline versus Heterocyclics.
Figure 10
Figure 10
Forest plot of comparison: 1 Failure to respond at endpoint (6 - 12 weeks), outcome: 1.3 Sertraline versus other SSRIs.
Figure 11
Figure 11
Forest plot of comparison: 4 Failure to remission at endpoint (6 - 12 weeks), outcome: 4.3 Sertraline versus other SSRIs.
Figure 12
Figure 12
Forest plot of comparison: 7 Standardised mean difference at endpoint (6 - 12 weeks), outcome: 7.3 Sertraline versus other SSRIs.
Figure 13
Figure 13
Forest plot of comparison: 10 Failure to complete (any cause), outcome: 10.3 Sertraline versus other SSRIs.
Figure 14
Figure 14
Forest plot of comparison: 1 Failure to respond at endpoint (6 - 12 weeks), outcome: 1.4 Sertraline versus newer ADs.
Figure 15
Figure 15
Forest plot of comparison: 4 Failure to remission at endpoint (6 - 12 weeks), outcome: 4.4 Sertraline versus newer ADs.
Figure 16
Figure 16
Forest plot of comparison: 7 Standardised mean difference at endpoint (6 - 12 weeks), outcome: 7.4 Sertraline versus newer ADs.
Figure 17
Figure 17
Forest plot of comparison: 10 Failure to complete (any cause), outcome: 10.4 Sertraline versus newer ADs.
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References

References to studies included in this review

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References to studies awaiting assessment

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