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Drug Class Review: Second-Generation Antidepressants
Drug Class Reviews
Gerald Gartlehner, MD, MPH, Richard A Hansen, PhD, Ursula Reichenpfader, MD, MPH, Angela Kaminski, MD, Christina Kien, MSc, Michaela Strobelberger, MA, Megan Van Noord, MSIS, Patricia Thieda, MA, Kylie Thaler, MD, MPH, and Bradley Gaynes, MD, MPH.
Author Information and AffiliationsStructured Abstract
Purpose:
We compared the effectiveness and harms of second-generation antidepressants in the treatment of major depressive disorder (MDD), dysthymia, subsyndromal depression, seasonal affective disorder, generalized anxiety disorder, obsessive compulsive disorder, panic disorder, post-traumatic stress disorder, social anxiety disorder, and premenstrual dysphoric disorder.
Data Sources:
We searched PubMed, Embase, PsycINFO, the Cochrane Library, and the International Pharmaceutical Abstracts until September 2010. For additional data we also hand searched reference lists, US Food and Drug Administration medical and statistical reviews and dossiers submitted by pharmaceutical companies.
Review Methods:
Study selection, data abstraction, validity assessment, grading the strength of the evidence, and data synthesis were all carried out according to standard Drug Effectiveness Review Project review methods.
Results and Conclusions:
Overall, we found no substantial differences in comparative efficacy and effectiveness of second-generation antidepressants for the treatment of depressive or anxiety disorders. Differences exist in the incidence of specific adverse events and the onset of action. Except for MDD, the evidence is limited to few direct comparisons for most indications. No head-to-head evidence is available for MDD in pediatric populations, dysthymia, subsyndromal depression, seasonal affective disorder, and premenstrual dysphoric disorder.
Contents
- Introduction
- Methods
- Results
- Overview
- Key Question 1. For outpatients with depressive, anxiety, adjustment, and/or premenstrual dysphoric disorder, do second-generation antidepressants differ in efficacy?
- Key Question 2. For outpatients with depressive, anxiety, and/or premenstrual dysphoric disorder, do second-generation antidepressants differ in safety, tolerability, or adverse events?
- Key Question 3. Are there subgroups of patients based on demographics (age, racial groups, sex), other medications, or co-morbidities for which one second-generation antidepressant is more effective or associated with fewer adverse events?
- Summary
- Conclusions
- Addendum
- References
- Appendixes
- Appendix A. Search strategy
- Appendix B. Methods for Drug Class Reviews for Oregon Health Plan Practitioner-Managed Prescription Drug Plan; Oregon Health and Science University Evidence-based Practice Center
- Appendix C. Characteristics of excluded studies for poor quality
- Appendix D. Abstract-only studies (not included)
- Appendix E. Pharmacokinetic properties and drug interactions
- Appendix F. Black box warnings of drugs approved by the US Food and Drug Administration
- Appendix G. Abbreviation Guide
- Appendix H. Glossary
- Evidence Tables
Update 4: October 2008; Update 3: September 2006; Update 2: March 2006; Update 1: July 2005; Original Report: November 2004
The medical literature relating to this topic is scanned periodically. (See http://www.ohsu.edu/ohsuedu/research/policycenter/DERP/about/methods.cfm for description of scanning process). Prior versions of this report can be accessed at the DERP website.
Drug Effectiveness Review Project: Marian McDonagh, PharmD, Principal Investigator
Oregon Evidence-based Practice Center: Mark Helfand, MD, MPH, Director
Acknowledgments: We thank Irene Wild for database management, retrieval of articles, and assistance with editing and formatting. We also thank Leah Williams, our publications editor, for putting this report into its present form for you to read.
Suggested citation:
Gartlehner G, Hansen RA, Reichenpfader U, Kaminski A, Kien C, Strobelberger M, Van Noord M, Thieda P, ThalerK, , Gaynes B. Drug class review: Second-generation antidepressants. Update 5. http://www.ohsu.edu/drugeffectiveness/reports/final.cfm
The purpose of Drug Effectiveness Review Project reports is to make available information regarding the comparative clinical effectiveness and harms of different drugs. Reports are not usage guidelines, nor should they be read as an endorsement of or recommendation for any particular drug, use, or approach. Oregon Health & Science University does not recommend or endorse any guideline or recommendation developed by users of these reports.
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