Fluoxetine versus other types of pharmacotherapy for depression.

Laura R. Magni, Marianna Purgato, Chiara Gastaldon, Davide Papola, Toshi A. Furukawa, Andrea Cipriani, Corrado Barbui

Research output: Contribution to journalArticle

48 Citations (Scopus)

Abstract

Depression is common in primary care and is associated with marked personal, social and economic morbidity, thus creating significant demands on service providers. The antidepressant fluoxetine has been studied in many randomised controlled trials (RCTs) in comparison with other conventional and unconventional antidepressants. However, these studies have produced conflicting findings.Other systematic reviews have on a dichotomous outcome (reduction of at least 50% on the Hamilton Depression Scale) (OR 0.97, 95% CI 0.77 to 1.22, 24 RCTs, 2124 participants) and a continuous outcome (mean scores at the end of the trial or change score on depression measures) (SMD 0.03, 95% CI -0.07 to 0.14, 50 RCTs, 3393 participants). On a dichotomousoutcome, fluoxetine was less effective than dothiepin or dosulepin (OR 2.13, 95% CI 1.08 to 4.20; number needed to treat (NNT) =6, 95% CI 3 to 50, 2 RCTs, 144 participants), sertraline (OR 1.37, 95% CI 1.08 to 1.74; NNT = 13, 95% CI 7 to 58, 6 RCTs, 1188 participants), mirtazapine (OR 1.46, 95% CI 1.04 to 2.04; NNT = 12, 95% CI 6 to 134, 4 RCTs, 600 participants) and venlafaxine(OR 1.29, 95% CI 1.10 to 1.51; NNT = 11, 95% CI 8 to 16, 12 RCTs, 3387 participants). On a continuous outcome, fluoxetine was more effective than ABT-200 (SMD -1.85, 95% CI -2.25 to -1.45, 1 RCT, 141 participants) and milnacipran (SMD -0.36, 95% CI-0.63 to -0.08, 2 RCTs, 213 participants); conversely, it was less effective than venlafaxine (SMD 0.10, 95% CI 0 to 0.19, 13 RCTs,3097 participants). Fluoxetine was better tolerated than TCAs considered as a group (total dropout OR 0.79, 95% CI 0.65 to 0.96;NNT = 20, 95% CI 13 to 48, 49 RCTs, 4194 participants) and was better tolerated in comparison with individual ADs, in particular amitriptyline (total dropout OR 0.62, 95% CI 0.46 to 0.85; NNT = 13, 95% CI 8 to 39, 18 RCTs, 1089 participants), and among the newer ADs ABT-200 (total dropout OR 0.18, 95% CI 0.08 to 0.39; NNT = 3, 95% CI 2 to 5, 1 RCT, 144 participants), pramipexole(total dropout OR 0.12, 95% CI 0.03 to 0.42, NNT = 3, 95% CI 2 to 5, 1 RCT, 105 participants), and reboxetine (total dropout OR0.60, 95% CI 0.44 to 0.82, NNT = 9, 95% CI 6 to 24, 4 RCTs, 764 participants). The present study detected differences in terms of efficacy and tolerability between fluoxetine and certain ADs, but the clinical meaning of these differences is uncertain.Moreover, the assessment of quality with the risk of bias tool showed that the great majority of included studies failed to report details on methodological procedures. Of consequence, no definitive implications can be drawn from the studies' results. The better efficacy profile of sertraline and venlafaxine (and possibly other ADs) over fluoxetine may be clinically meaningful,as already suggested by other systematic reviews. In addition to efficacy data, treatment decisions should also be based on considerations of drug toxicity, patient acceptability and cost.

Original languageEnglish
JournalThe Cochrane database of systematic reviews
Volume7
Publication statusPublished - 2013

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Fluoxetine
Randomized Controlled Trials
Numbers Needed To Treat
Drug Therapy
Dothiepin
Sertraline
Antidepressive Agents
Amitriptyline
Drug-Related Side Effects and Adverse Reactions

ASJC Scopus subject areas

  • Medicine(all)

Cite this

Magni, L. R., Purgato, M., Gastaldon, C., Papola, D., Furukawa, T. A., Cipriani, A., & Barbui, C. (2013). Fluoxetine versus other types of pharmacotherapy for depression. The Cochrane database of systematic reviews, 7.

Fluoxetine versus other types of pharmacotherapy for depression. / Magni, Laura R.; Purgato, Marianna; Gastaldon, Chiara; Papola, Davide; Furukawa, Toshi A.; Cipriani, Andrea; Barbui, Corrado.

In: The Cochrane database of systematic reviews, Vol. 7, 2013.

Research output: Contribution to journalArticle

Magni, LR, Purgato, M, Gastaldon, C, Papola, D, Furukawa, TA, Cipriani, A & Barbui, C 2013, 'Fluoxetine versus other types of pharmacotherapy for depression.', The Cochrane database of systematic reviews, vol. 7.
Magni LR, Purgato M, Gastaldon C, Papola D, Furukawa TA, Cipriani A et al. Fluoxetine versus other types of pharmacotherapy for depression. The Cochrane database of systematic reviews. 2013;7.
Magni, Laura R. ; Purgato, Marianna ; Gastaldon, Chiara ; Papola, Davide ; Furukawa, Toshi A. ; Cipriani, Andrea ; Barbui, Corrado. / Fluoxetine versus other types of pharmacotherapy for depression. In: The Cochrane database of systematic reviews. 2013 ; Vol. 7.
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title = "Fluoxetine versus other types of pharmacotherapy for depression.",
abstract = "Depression is common in primary care and is associated with marked personal, social and economic morbidity, thus creating significant demands on service providers. The antidepressant fluoxetine has been studied in many randomised controlled trials (RCTs) in comparison with other conventional and unconventional antidepressants. However, these studies have produced conflicting findings.Other systematic reviews have on a dichotomous outcome (reduction of at least 50{\%} on the Hamilton Depression Scale) (OR 0.97, 95{\%} CI 0.77 to 1.22, 24 RCTs, 2124 participants) and a continuous outcome (mean scores at the end of the trial or change score on depression measures) (SMD 0.03, 95{\%} CI -0.07 to 0.14, 50 RCTs, 3393 participants). On a dichotomousoutcome, fluoxetine was less effective than dothiepin or dosulepin (OR 2.13, 95{\%} CI 1.08 to 4.20; number needed to treat (NNT) =6, 95{\%} CI 3 to 50, 2 RCTs, 144 participants), sertraline (OR 1.37, 95{\%} CI 1.08 to 1.74; NNT = 13, 95{\%} CI 7 to 58, 6 RCTs, 1188 participants), mirtazapine (OR 1.46, 95{\%} CI 1.04 to 2.04; NNT = 12, 95{\%} CI 6 to 134, 4 RCTs, 600 participants) and venlafaxine(OR 1.29, 95{\%} CI 1.10 to 1.51; NNT = 11, 95{\%} CI 8 to 16, 12 RCTs, 3387 participants). On a continuous outcome, fluoxetine was more effective than ABT-200 (SMD -1.85, 95{\%} CI -2.25 to -1.45, 1 RCT, 141 participants) and milnacipran (SMD -0.36, 95{\%} CI-0.63 to -0.08, 2 RCTs, 213 participants); conversely, it was less effective than venlafaxine (SMD 0.10, 95{\%} CI 0 to 0.19, 13 RCTs,3097 participants). Fluoxetine was better tolerated than TCAs considered as a group (total dropout OR 0.79, 95{\%} CI 0.65 to 0.96;NNT = 20, 95{\%} CI 13 to 48, 49 RCTs, 4194 participants) and was better tolerated in comparison with individual ADs, in particular amitriptyline (total dropout OR 0.62, 95{\%} CI 0.46 to 0.85; NNT = 13, 95{\%} CI 8 to 39, 18 RCTs, 1089 participants), and among the newer ADs ABT-200 (total dropout OR 0.18, 95{\%} CI 0.08 to 0.39; NNT = 3, 95{\%} CI 2 to 5, 1 RCT, 144 participants), pramipexole(total dropout OR 0.12, 95{\%} CI 0.03 to 0.42, NNT = 3, 95{\%} CI 2 to 5, 1 RCT, 105 participants), and reboxetine (total dropout OR0.60, 95{\%} CI 0.44 to 0.82, NNT = 9, 95{\%} CI 6 to 24, 4 RCTs, 764 participants). The present study detected differences in terms of efficacy and tolerability between fluoxetine and certain ADs, but the clinical meaning of these differences is uncertain.Moreover, the assessment of quality with the risk of bias tool showed that the great majority of included studies failed to report details on methodological procedures. Of consequence, no definitive implications can be drawn from the studies' results. The better efficacy profile of sertraline and venlafaxine (and possibly other ADs) over fluoxetine may be clinically meaningful,as already suggested by other systematic reviews. In addition to efficacy data, treatment decisions should also be based on considerations of drug toxicity, patient acceptability and cost.",
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T1 - Fluoxetine versus other types of pharmacotherapy for depression.

AU - Magni, Laura R.

AU - Purgato, Marianna

AU - Gastaldon, Chiara

AU - Papola, Davide

AU - Furukawa, Toshi A.

AU - Cipriani, Andrea

AU - Barbui, Corrado

PY - 2013

Y1 - 2013

N2 - Depression is common in primary care and is associated with marked personal, social and economic morbidity, thus creating significant demands on service providers. The antidepressant fluoxetine has been studied in many randomised controlled trials (RCTs) in comparison with other conventional and unconventional antidepressants. However, these studies have produced conflicting findings.Other systematic reviews have on a dichotomous outcome (reduction of at least 50% on the Hamilton Depression Scale) (OR 0.97, 95% CI 0.77 to 1.22, 24 RCTs, 2124 participants) and a continuous outcome (mean scores at the end of the trial or change score on depression measures) (SMD 0.03, 95% CI -0.07 to 0.14, 50 RCTs, 3393 participants). On a dichotomousoutcome, fluoxetine was less effective than dothiepin or dosulepin (OR 2.13, 95% CI 1.08 to 4.20; number needed to treat (NNT) =6, 95% CI 3 to 50, 2 RCTs, 144 participants), sertraline (OR 1.37, 95% CI 1.08 to 1.74; NNT = 13, 95% CI 7 to 58, 6 RCTs, 1188 participants), mirtazapine (OR 1.46, 95% CI 1.04 to 2.04; NNT = 12, 95% CI 6 to 134, 4 RCTs, 600 participants) and venlafaxine(OR 1.29, 95% CI 1.10 to 1.51; NNT = 11, 95% CI 8 to 16, 12 RCTs, 3387 participants). On a continuous outcome, fluoxetine was more effective than ABT-200 (SMD -1.85, 95% CI -2.25 to -1.45, 1 RCT, 141 participants) and milnacipran (SMD -0.36, 95% CI-0.63 to -0.08, 2 RCTs, 213 participants); conversely, it was less effective than venlafaxine (SMD 0.10, 95% CI 0 to 0.19, 13 RCTs,3097 participants). Fluoxetine was better tolerated than TCAs considered as a group (total dropout OR 0.79, 95% CI 0.65 to 0.96;NNT = 20, 95% CI 13 to 48, 49 RCTs, 4194 participants) and was better tolerated in comparison with individual ADs, in particular amitriptyline (total dropout OR 0.62, 95% CI 0.46 to 0.85; NNT = 13, 95% CI 8 to 39, 18 RCTs, 1089 participants), and among the newer ADs ABT-200 (total dropout OR 0.18, 95% CI 0.08 to 0.39; NNT = 3, 95% CI 2 to 5, 1 RCT, 144 participants), pramipexole(total dropout OR 0.12, 95% CI 0.03 to 0.42, NNT = 3, 95% CI 2 to 5, 1 RCT, 105 participants), and reboxetine (total dropout OR0.60, 95% CI 0.44 to 0.82, NNT = 9, 95% CI 6 to 24, 4 RCTs, 764 participants). The present study detected differences in terms of efficacy and tolerability between fluoxetine and certain ADs, but the clinical meaning of these differences is uncertain.Moreover, the assessment of quality with the risk of bias tool showed that the great majority of included studies failed to report details on methodological procedures. Of consequence, no definitive implications can be drawn from the studies' results. The better efficacy profile of sertraline and venlafaxine (and possibly other ADs) over fluoxetine may be clinically meaningful,as already suggested by other systematic reviews. In addition to efficacy data, treatment decisions should also be based on considerations of drug toxicity, patient acceptability and cost.

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