Effekt og sikkerhet for SSRI og andre nyere antidepressive legemidler ved depresjon hos voksne
Peer reviewed, Research report
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http://hdl.handle.net/11250/2378551Utgivelsesdato
2007-06Metadata
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Rapport fra Kunnskapssenteret 17/2007Sammendrag
KEY MESSAGES:
Efficacy and safety for the newer antidepressants in adults
Background Depression is a varied illness, patients may present with symptoms such as
lack of initiative, a sense of meaninglessness, depressive thoughts and/or suicidal behaviour.
Problems with sleep, lack of appetite, energy, drive, anxiety and concentration are
also common. Our understanding of the neurobiological causes of depression is incomplete.
Reduced accessibility of monoaminerge neurotransmitters in the central nervous
systems is one possible explanation. Several antidepressant drugs are available. SSRI (selective
serotonin reuptake inhibitors) and other second generation anti depressants have
been increasingly used in recent years.
Antidepressants increase the accessibility of serotonin and/or noradrenalin, either by
inhibiting the reuptake or inhibiting the decomposition. This does not seem to explain
the effect.
Methods We have systematically reviewed the literature for effect and safety in head-tohead
studies of SSRI and other second generation antidepressants used in adults with
depression. The literature was identified by a systematic search in international, electronic
databases. We also received literature from the pharmaceutical industry. We assessed
and summarised studies that fulfilled our predetermined criteria.
Results 23 studies are included in the report. The 23 studies deal with 12 different comparisons
out of 66 possible. Nine different antidepressants were compared. The documentation
is of low quality for most of the comparisons. We did not find any differences
in effect and safety in the head-to-head studies we analyzed with the exception of:
Escitalopram was significantly more effective (response and remission rate) than citalopram.
Loss to follow up was significantly lower for escitalopram than for citalopram.
Citalopram had a significantly lower adverse event rate than venlafaxin. Mirtazapin was
significantly more effective (remission rate) than paroxetin. Loss to follow up due to side
effects was significantly lower for fluoksetin than for venlafaxin.
.
Conclusion We have included 12 different head-to head comparisons out of 66 possible.
Nine different antidepressants were involved in the comparisons. We did not find any
significant differences in effect and safety between the antidepressants except for the
comparisons escitalopram versus citalopram, citalopram versus venlafaxin and mirtazapin
versus paroxetin where we found significant differences for some of the outcomes.
The conclusions are based on documentation of medium or low quality.
Utgiver
Norwegian Knowledge Centre for the Health ServicesSerie
Rapport fra Kunnskapssenteret17/2007
Report from NOKC
17/2007