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Discontinuation rates of SSRIs and tricyclic antidepressants: a meta-analysis and investigation of heterogeneity.

Hotopf, M; Hardy, R; Lewis, G; (1997) Discontinuation rates of SSRIs and tricyclic antidepressants: a meta-analysis and investigation of heterogeneity. Br J Psychiatry , 170 pp. 120-127. 10.1192/bjp.170.2.120.

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Abstract

BACKGROUND: Previous meta-analyses suggest that individuals treated with serotonin-specific reuptake inhibitors (SSRIs) in randomised controlled trials (RCTs) are less likely to discontinue treatment than those on tricyclic antidepressants. This metaanalysis investigates whether this is due to the frequent use in RCTs of older reference tricyclics (imipramine and amitriptyline), which may have worse side-effects than more recent compounds. METHODS: A meta-analysis of RCTs comparing tricyclic and heterocyclic antidepressants with SSRIs in the treatment of depression. RESULTS: The overall odds ratio of discontinuation on tricyclic/heterocyclic antidepressants compared with SSRIs was 0.86 (95% CI 0.78-0.94). The odds ratio for reference tricyclics was 0.82 95% CI 0.72-0.23), newer tricyclics 0.89 (95% CI 0.74-1.06), and heterocyclics 1.02 (95% CI 0.78-1.35). The pooled advantage of SSRIs over tricyclics was maintained whether the population studied consisted of younger adults or only the elderly. No differences in discontinuation rates were detected between the SSRIs. CONCLUSIONS: The lower rate of discontinuation in patients on SSRIs may be due to the use of old tricyclics (which have worse side-effects) as reference compounds. The SSRIs do not show a statistically significant difference in discontinuation rates when compared with newer tricyclics or heterocyclics.

Type: Article
Title: Discontinuation rates of SSRIs and tricyclic antidepressants: a meta-analysis and investigation of heterogeneity.
Location: England
DOI: 10.1192/bjp.170.2.120
Keywords: Antidepressive Agents, Tricyclic, Depressive Disorder, Humans, Odds Ratio, Randomized Controlled Trials as Topic, Serotonin Uptake Inhibitors, Treatment Refusal
UCL classification: UCL > Provost and Vice Provost Offices
UCL > Provost and Vice Provost Offices > School of Education
UCL > Provost and Vice Provost Offices > School of Education > UCL Institute of Education
UCL > Provost and Vice Provost Offices > School of Education > UCL Institute of Education > IOE - Social Science
UCL > Provost and Vice Provost Offices > School of Life and Medical Sciences
UCL > Provost and Vice Provost Offices > School of Life and Medical Sciences > Faculty of Brain Sciences
UCL > Provost and Vice Provost Offices > School of Life and Medical Sciences > Faculty of Brain Sciences > Division of Psychiatry
URI: http://discovery.ucl.ac.uk/id/eprint/1486496
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