Adverse effects associated with selective serotonin reuptake inhibitors and tricyclic antidepressants: a meta-analysis (original) (raw)
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A Review Article on Selective Serotonin Reuptake Inhibitors (SSRIS)
Asian Journal of Pharmaceutical Research and Development, 2019
Depression, tension and mental health have been ignored as a serious issue since ages. Depression can be fatal or life-threatening, if not treated to this problem. Antidepressants are also regularly used to treat many other conditions, such as social phobia, fibromyalgia, panic disorder, anxiety/anxiety depression, PTSD, OCD, PMDD, and menopause. The major antidepressant used in the study followed oral prescribing trends. A “serious adverse reaction means an adverse reaction which is fatal, life-threatening, disabling, incapacitating, or which results in or prolongs hospitalization.” Material method collect from Google, Wikipedia, Elsevier, PubMed, Google scholar, Sci-Hub etc. This is a meta-analysis study. Fluoxetine have the longest half-life, but Fluvoxamine have short half-life. SSRIs increase the serum concentrations of the latter two drugs, potentiating their effects and increasing the risk of toxicity. Fluoxetine and Paroxetine specifically, are known to cause a 5-fold increa...
Depression and Anxiety, 1998
A meta-analysis of the efficacy and tolerability of selective serotonin reuptake inhibitors (SSRIs) against nonselective and noradrenergic reuptake inhibitors (mainly tricyclic antidepressants, TCAs) in depressed inpatients was carried out. Twenty-five double-blind studies provided data on relative efficacy which was determined by a summary variance-weighted mean effect size calculated from the difference in the reduction in mean Hamilton Depression Rating Scale (HDRS) scores for the two antidepressants in each study. Twenty-three studies provided data on dropouts and relative tolerability which was determined as the variance-weighted pooling of the relative risk (RR) of dropout for all reasons and for adverse effects from each study. TCAs were significantly more effective than SSRIs (effect size =-0.23, 95% CI-0.40 to-0.05, P = 0.011), although sensitivity analyses by analysing larger studies (>100 patients) and those providing complete data reduced the advantage to TCAs to a trend (P < 0.10). When the TCAs were grouped into those with dual action on 5-hydroxytryptamine (HT) and noradrenaline reuptake (clomipramine and amitriptyline) and those with predominantly noradrenaline reuptake (imipramine, desipramine and maprotiline), only the dual action TCAs had greater efficacy than SSRIs (effect size =-0.30, 95% CI-0.54 to-0.05, P = 0.017). When TCAs were considered individually, only amitriptyline was significantly more effective than comparator SSRIs (effect size =-0.37, 95% CI-0.67 to-0.07, P = 0.015). More patients overall discontinued treatment on TCAs than on SSRIs (29.0% vs. 25.5%), although this did not reach statistical significance (RR = 0.88, 95% CI 0.75 to 1.03, P = 0.121). However, significantly more patients stopped treatment due to adverse effects on TCAs compared to SSRIs (14.2% vs. 9.1%, RR = 0.66, 95% CI 0.50 to 0.87, P = 0.003) with no difference in discontinuations due to treatment failure (10% vs. 11.6%, RR = 1.13, 95% CI 0.84 to 1.51, P = 0.42). This meta-analysis suggests that at least some TCAs may be more effective than SSRIs in depressed inpatients, with there being the strongest evidence for amitriptyline. A possible explanation is that this is related to a dual action in inhibiting both 5-HT and noradrenaline reuptake. In agreement with previous meta-analyses, TCAs appear less well tolerated than SSRIs, although the absolute risk difference for discontinuation due to adverse effects (4.9%, 95% CI-8.1 to-1.7%) is of uncertain clinical significance.
2003
Objective To compare the efficacy and tolerability of tricyclic antidepressants with selective serotonin reuptake inhibitors in depression in primary care. Design Systematic review and meta-analysis of randomised controlled trials. Data sources Register of the Cochrane Collaboration's depression, anxiety, and neurosis group. Reference lists of initial studies and other relevant review papers. Selected authors and experts. Selection of studies Studies had to meet minimum requirements on: adequacy of sample size, adequate allocation concealment, clear description of treatment, representative source of subjects, use of diagnostic criteria or clear specification of inclusion criteria, details regarding number and reasons for withdrawal by group, and outcome measures described clearly or use of validated instruments. Main outcome measures Standardised mean difference of final mean depression scores and relative risk of response when using the clinical global impression score. Relative risk of withdrawing from treatment at any time, and the number withdrawing due to side effects. Results 11 studies (2951 participants) compared a selective serotonin reuptake inhibitor with a tricyclic antidepressant. Efficacy between selective serotonin reuptake inhibitors and tricyclics did not differ significantly (standardised weighted mean difference, fixed effects 0.07, 95% confidence interval − 0.02 to 0.15; z=1.59, P < 0.11). Significantly more patients receiving a tricyclic withdrew from treatment (relative risk 0.78, 95% confidence interval 0.68 to 0.90; z=3.37, P < 0.0007) and withdrew specifically because of side effects (0.73, 0.60 to 0.88; z=3.24, P < 0.001). Most studies included were small and supported by commercial funding. Many studies were of low methodological quality or did not present adequate data for analysis, or both, and were of short duration, typically six to eight weeks. Conclusion The evidence on the relative efficacy of selective serotonin reuptake inhibitors and tricyclic antidepressants in primary care is sparse and of variable quality. The study setting is likely to be an important factor in assessing the efficacy and tolerability of treatment with antidepressant drugs.
2005
2.1 Withdrawal reactions in association with SSRIs 2.2 Suicidal behaviour in association with SSRIs 3 Burden of depressive illness and self-harm 3.1 Depressive illness 3.2 The epidemiology of suicide and non-fatal self-harm 4 Introduction to pharmacovigilance and data sources 4.1 Pharmacovigilance 4.2 Approaches to pharmacovigilance at the MHRA 5 Neuropsychiatric adverse effects of SSRIs and related antidepressants: pharmacological considerations 5.1 Pharmacology of SSRIs 6 Safety and efficacy in children and adolescents with major depressive disorder 6.1 Clinical trial data on safety and efficacy in children under 18 years with major depressive disorder 6.2 Studies using the UK General Practice Research Database 6.3 Conclusions iv 6.4 Key findings 6.5 Regulatory options and clinical implications 6.6 Publication of advice on paediatric use 6.7 Further activity following CSM advice 7 Suicidal behaviour 7.1 Published evidence 7.2 Clinical trial data on suicide, self-harm and suicidal thoughts 7.3 Studies using the UK General Practice Research Database 7.4 Spontaneous reporting data from health professionals 7.5 Patients' experiences 7.6 Overall discussion 7.7 Key findings 8 Withdrawal reactions and potential for dependence 8.1 Withdrawal reactions 8.2 Drug dependence and abuse 8.3 Neonatal withdrawal symptoms/complications 8.4 Overall conclusions 8.5 Key findings 9 Dose response 9.1 Background 9.2 Types of clinical trials for assessing dose response 9.3 Data considered 9.4 Overall conclusions 9.5 Key findings 10 The patient experience 10.1 Background 10.2 Patient reports 10.3 Improving the quality of patient information 10.4 Conclusion 11 The way forward and further research required 11.1 Main findings 11.2 Research requirements 11.3 Recommendations for the conduct of future clinical trials of antidepressants
British Medical …, 2003
Objective To compare the efficacy and tolerability of tricyclic antidepressants with selective serotonin reuptake inhibitors in depression in primary care. Design Systematic review and meta-analysis of randomised controlled trials. Data sources Register of the Cochrane Collaboration's depression, anxiety, and neurosis group. Reference lists of initial studies and other relevant review papers. Selected authors and experts. Selection of studies Studies had to meet minimum requirements on: adequacy of sample size, adequate allocation concealment, clear description of treatment, representative source of subjects, use of diagnostic criteria or clear specification of inclusion criteria, details regarding number and reasons for withdrawal by group, and outcome measures described clearly or use of validated instruments. Main outcome measures Standardised mean difference of final mean depression scores and relative risk of response when using the clinical global impression score. Relative risk of withdrawing from treatment at any time, and the number withdrawing due to side effects. Results 11 studies (2951 participants) compared a selective serotonin reuptake inhibitor with a tricyclic antidepressant. Efficacy between selective serotonin reuptake inhibitors and tricyclics did not differ significantly (standardised weighted mean difference, fixed effects 0.07, 95% confidence interval − 0.02 to 0.15; z=1.59, P < 0.11). Significantly more patients receiving a tricyclic withdrew from treatment (relative risk 0.78, 95% confidence interval 0.68 to 0.90; z=3.37, P < 0.0007) and withdrew specifically because of side effects (0.73, 0.60 to 0.88; z=3.24, P < 0.001). Most studies included were small and supported by commercial funding. Many studies were of low methodological quality or did not present adequate data for analysis, or both, and were of short duration, typically six to eight weeks. Conclusion The evidence on the relative efficacy of selective serotonin reuptake inhibitors and tricyclic antidepressants in primary care is sparse and of variable quality. The study setting is likely to be an important factor in assessing the efficacy and tolerability of treatment with antidepressant drugs.
Journal of Affective Disorders, 1999
Background: With the advent of the selective serotonin reuptake inhibitors (SSRIs), the use of antidepressants has increased drastically in Sweden. The use of tricyclic antidepressants (TCAs) has, however, decreased. Methods: Wë surveyed a prescription database in the Swedish county of Jamtland and compared prescription patterns for patients prescribed SSRIs with those prescribed TCAs. Results: The incidence of treatments of antidepressants increased from 0.76% to 1.33% during the period 1991-1996. There were no significant differences between SSRIs and TCAs with regard to patients having only one prescription dispensed within three months from the index prescription, or patients who switched class of antidepressant. Only a minority of the treatments were continued for at least six months, but significantly more SSRI than TCA treatments (42% and 27%). A second treatment period suggesting recurrence was three-times more common in the TCA group than in the SSRI group. Conclusion: Provided that the increased use of SSRIs is mainly for depression, these drugs appear, despite a lower efficacy in severe depression, to have enabled a broader utilisation of antidepressants with regard to incidence, dosage and duration, in accordance with recommendations. Further analyses of this phenomenon relative to diagnostic criteria and outcome measures are required.