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Arch Gen Psychiatry. 2006 Nov;63(11):1217-23.

Early onset of selective serotonin reuptake inhibitor antidepressant action: systematic review and meta-analysis.

Author information

1
Department of Psychiatry, University of Oxford, Warneford Hospital, Oxford, England. matthew.taylor@psych.ox.ac.uk

Abstract

CONTEXT:

Selective serotonin reuptake inhibitors (SSRIs) are often described as having a delayed onset of effect in the treatment of depression. However, some trials have reported clinical improvement as early as the first week of treatment.

OBJECTIVE:

To test the alternative hypotheses of delayed vs early onset of antidepressant action with SSRIs in patients with unipolar depression.

DATA SOURCES:

Trials identified by searching CENTRAL, The Cochrane Collaboration database of controlled trials (2005), and the reference lists of identified trials and other systematic reviews.

STUDY SELECTION:

Randomized controlled trials of SSRIs vs placebo for the treatment of unipolar depression in adults that reported outcomes for at least 2 time points in the first 4 weeks of treatment (50 trials from >500 citations identified). Trials were excluded if limited to participants older than 65 years or specific comorbidities.

DATA EXTRACTION:

Data were extracted on trial design, participant characteristics, and outcomes by a single reviewer.

DATA SYNTHESIS:

Pooled estimates of treatment effect on depressive symptom rating scales were calculated for weeks 1 through 6 of treatment. In the primary analysis, the pattern of response seen was tested against alternative models of onset of response. The primary analysis incorporated data from 28 randomized controlled trials (n=5872). A model of early treatment response best fit the experimental data. Treatment with SSRIs rather than placebo was associated with clinical improvement by the end of the first week of use. A secondary analysis indicated an increased chance of achieving a 50% reduction in Hamilton Depression Rating Scale scores by 1 week (relative risk, 1.64; 95% confidence interval, 1.2-2.25) with SSRI treatment compared with placebo.

CONCLUSIONS:

Treatment with SSRIs is associated with symptomatic improvement in depression by the end of the first week of use, and the improvement continues at a decreasing rate for at least 6 weeks.

PMID:
17088502
PMCID:
PMC2211759
DOI:
10.1001/archpsyc.63.11.1217
[Indexed for MEDLINE]
Free PMC Article

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