Are All Antidepressants Really the Same? The Case of Fluoxetine: A Systematic Review
J Clin Psychiatry 2006;67(6):850-864
© Copyright 2014 Physicians Postgraduate Press, Inc.
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Objective: To systematically review the
efficacy and tolerability of fluoxetine, the most widely studied of newer antidepressants, in
comparison with all other antidepressants in the
acute treatment of depression in patients aged
more than 18 years.
Data Sources: Studies were identified
through electronic searches of the Cochrane
Collaboration Depression, Anxiety and Neurosis
Controlled Trials Register and the Cochrane Central
Register of Controlled Trials up to March 2004. The
terms FLUOXETIN* OR adofen or
docutrix or erocap or fluctin
or fluctine or fluoxeren or
fontex or ladose or lorien
or lovan or mutan or
prozac or prozyn or reneuron or
sanzur or saurat or zactin were used. MEDLINE (1966-2004)
and EMBASE (1974-2004) were searched using
fluoxetine and randomized controlled
trial or random allocation or double-blind
method. No language restrictions were applied. Reference lists
of relevant papers and previous systematic reviews were hand-searched for published reports up
to March 2004.
Study Selection: Only randomized
controlled trials (either blind or nonblind) were included.
Data Synthesis: 131 randomized
controlled trials were eligible. A p value less than .01
was chosen to test the null hypothesis, and a 99%
confidence interval was calculated to detect
statistically significant differences with a high degree
of confidence. Fixed- and random-effects relative risks, odds ratios (ORs), and Peto ORs were
routinely calculated for each outcome measure. In terms of efficacy, we found a statistically
significant difference favoring sertraline and
venlafaxine over fluoxetine. In terms of tolerability,
patients allocated to fluoxetine were less likely
to leave the study early only in comparison with those allocated to amitriptyline and pramipexole.
Conclusions: This systematic review
highlighted that there are differences between
fluoxetine and specific comparator antidepressants.
Several of the differences met a prespecified criterion for clinical significance. The
statistical approach adopted in this systematic review
could represent a useful tool for putting clinical
trial data into practice.