The researchers looked at SSRIs, tricyclic and heterocyclic antidepressants, and newer antidepressants. The researchers analyzed participants' scores on several diagnostic scales for depression, comparing measurements on Prozac with other antidepressants.
Results were mixed: Prozac was found less effective than Prothiaden (dothiepin), Zoloft, Remeron (mirtazapine) and Effexor but more effective than the antidepressants ABT-200 and milnacipran. Prozac was better tolerated than tricyclic antidepressants as a group and with other individual antidepressants.
"Although the better effectiveness profile of sertraline and venlafaxine over fluoxetine seems meaningful, it needs further investigation," Cipriani said, noting that studies were short, usually eight weeks or less. "This limits the ability of the studies to show clinically meaningful differences," he said. "We need more robust and pragmatic evidence, free from industry influence."
According to Cipriani, fluoxetine's huge success has occurred despite the fact that "results from randomized clinical trials did not clearly indicate that it offered substantial benefits over conventional agents." Many studies have compared fluoxetine with other antidepressants, but he said a major problem with some of these studies is "that they have analyzed the SSRIs as a group and evidence applicable to this group of drugs might not be entirely applicable to fluoxetine alone."
Until additional, robust, unbiased evidence becomes available, Cipriani said that clinicians ought to base their selection upon considerations of drug toxicity, patient acceptability and cost.
"The great majority of randomized controlled trials have been sponsored by pharmaceutical industry and data have shown a possible relationship between industry sponsorship and trial outcomes," said Cipriani, "We need further analyses on the possible confounding role
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Contact: Andrea Cipriani
andrea.cipriani@univr.it
Center for the Advancement of Health
6-Dec-2005