A double-blind comparison of paroxetine and fluvoxamine in major depression

Ansseau, M; Gabriëls, A.; Loyens, J.; Bartholomé, F.; Evrard, Jean-Luc; Nayer, André; Linhart, R.; Wirtz, Janina; Bruynoghe, F.; Surinx, K.; Clarysse, H.; Marganne, R.; Papart, Patrick

doi:10.1016/0924-977x(93)90099-8

Cited by 9 publications

(5 citation statements)

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“…Comparisons of the various SSRIs in acute treatment have shown that, in general, they have similar overall efficacies (Ansseau et al, 1993;De Wilde et al, 1993;Gagiano, 1993;Tignol, 1993;Geretsegger et al, 1994;Nemeroff et al, 1995;Patris et al, 1996;Bougerol et al, 1997;Kiev and Fieger, 1997;Ontiveros and Garcia-Barriga, 1997; Table 2). However, some differences may exist among the SSRIs with respect to their effectiveness profiles in acute treatment in clinical practice.…”

Section: Introductionmentioning

confidence: 91%

Selective serotonin reuptake inhibitors in affective disorders -II. Efficacy and quality of life

Goodnick¹,

Goldstein

1998

J Psychopharmacol

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Since their introduction, the selective serotonin reuptake inhibitors (SSRIs) have become one of the most widely used classes of medication in psychiatry. Their popularity is based on apparent efficacy over a wide range of disorders and a favorable side-effect profile. However, as with any psychotropic medication, considerable data are required to define where a drug works and where it does not. There is now a wealth of evidence demonstrating that SSRIs may differ in their efficacy profiles in certain depressive symptoms, in different subtypes of depression, with respect to their ability to maintain efficacy over time, on broader outcomes such as quality of life, and in the consistency of the usually effective minimum therapeutic dose across the age spectrum and across indications. Although this review includes data on all SSRIs, it focuses on fluoxetine and sertraline, which in addition to being the most widely used SSRIs are also the most widely studied. The relative quantity and quality of data on these two SSRIs means that it is possible to make relatively firm inferences regarding their differential effects on affective symptoms and quality of life.

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Section: Introductionmentioning

confidence: 91%

Selective serotonin reuptake inhibitors in affective disorders -II. Efficacy and quality of life

Goodnick¹,

Goldstein

1998

J Psychopharmacol

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“…The first question we addressed was whether the different SSRIs differ in efficacy as there are only a few direct comparisons (e.g. Ansseau et al, 1993;De Wilde, Mertens and Wakelin, 1993).…”

Section: Subgroup Analysismentioning

confidence: 99%

The efficacy of selective serotonin re-uptake inhibitors in depression: a meta-analysis of studies against tricyclic antidepressants

1994

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A meta-analysis of the efficacy of five selective serotonin re-uptake inhibitors (SSRIs) against non-selective and noradrenergic re-uptake inhibitors (mainly tricyclic antidepressants, TCAs) is presented. Fifty five double- blind studies were identified after excluding those multiply reported or with methodological problems likely to bias the outcome in favour of SSRIs. Standardised effect sizes and 95% confidence intervals were calculated based on the difference in the reduction in mean Hamilton depression rating scale (HDRS) scores for the two antidepressants. For studies not reporting standard deviations, the pooled variance from complete studies was used and a variance-weighted mean effect size calculated. There were no differences in efficacy between SSRIs and comparator antidepressants for SSRIs taken together or individually. If studies were classified into high and low depression scores based on a median split of initial HDRS scores, there was a slight advantage to TCAs in the high HDRS group. In addition, SSRIs were slightly less effective than TCAs in in-patients and against combined serotonin and noradrenaline re-uptake inhibitors (clomipramine and amitriptyline). These findings were accounted for by a clinically significant lower efficacy of paroxetine in these subgroups. In contrast, SSRIs as a group were marginally more effective than noradrenergic antidepressants, a finding accounted for by two studies with sertraline. Fluvoxamine was the only SSRI to have been tested adequately in in-patients, where it displayed equal efficacy to TCAs. This meta-analysis confirms that SSRIs and TCAs are in general equally effective, but suggests that paroxetine's efficacy in in-patients and against clomipramine and amitriptyline is not proven.

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“…In addition, 18 studies used diagnostic criteria such as "major depressive episode" (DSM-III or IV) , "major affective disorder" (DSM-III), "depression" (Feighner criteria), or "unipolar or bipolar disorder" (Feighner criteria), and did not exclude patients with bipolar depression. Consequently, some studies might include patients with bipolar depression who were not specifically taken into account (Ansseau 1994;Barrelet 1991;Bocksberger 1993;Bougerol 1992;Brunner 1994;Cassano 1986;Coleman 1982;Dalery 2003;Dick 1983;Gonul 1999;Harris 1991a;Moon 1991;Mullin 1988;Perez 1990;Rahman 1991;Rota 2005;Zohar 2003). Some studies included less than 20% of depressive patients with psychotic features (Ansseau 1991a;Ansseau 1991b;Ansseau 1994;Asakura 2005;Bramanti 1988;Clerc 2001;Kasper 1990).…”

Section: Participantsmentioning

confidence: 99%

“…Consequently, some studies might include patients with bipolar depression who were not specifically taken into account (Ansseau 1994;Barrelet 1991;Bocksberger 1993;Bougerol 1992;Brunner 1994;Cassano 1986;Coleman 1982;Dalery 2003;Dick 1983;Gonul 1999;Harris 1991a;Moon 1991;Mullin 1988;Perez 1990;Rahman 1991;Rota 2005;Zohar 2003). Some studies included less than 20% of depressive patients with psychotic features (Ansseau 1991a;Ansseau 1991b;Ansseau 1994;Asakura 2005;Bramanti 1988;Clerc 2001;Kasper 1990). In 25 studies, some elderly subjects (over 65 years old) were included, but the actual number of elderly people was not reported in most trials.…”

Section: Participantsmentioning

confidence: 99%

“…Only one trial compared fluvoxamine with citalopram ) recorded a completed suicide (Analysis 7.25), and cited one event among 108 patients taking citalopram and no events among 109 patients taking fluvoxamine. Suicide attempts/ideation were reported in only four trials (Ansseau 1994;Dalery 2003;, with 6 events among 314 patients taking fluvoxamine and 2 patients among 307 patients taking other SSRIs (i.e., paroxetine, fluoxetine and citalopram) (Analysis 9.18, Analysis 9.19).…”

Section: Neuropsychiatric Side Effectsmentioning

confidence: 99%

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Fluvoxamine versus other anti-depressive agents for depression

Omori

Watanabe

Nakagawa

et al. 2010

Cochrane Database of Systematic Reviews

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Background Fluvoxamine, one of the oldest selective serotonin reuptake inhibitors (SSRIs), is prescribed to patients with major depression in many countries. Several studies have previously reviewed the efficacy and tolerability of fluvoxamine for the treatment of major depression. However, these reviews are now outdated. Objectives Our objective is to evaluate the effectiveness, tolerability and side effect profile of fluvoxamine for major depression in comparison with other anti-depressive agents, including tricyclics (TCAs), heterocyclics, other SSRIs, SNRIs, other newer agents and other conventional psychotropic drugs. Search methods We searched the Cochrane Collaboration Depression, Anxiety and Neurosis Controlled Trials Register. Trial databases and ongoing trial registers in North America, Europe, Japan and Australia, were handsearched for randomised controlled trials. We checked reference lists of the articles included in the review, previous systematic reviews and major textbooks of affective disorder for published reports and citations of unpublished research. The date of last search was 31 August 2008. Selection criteria We included all randomised controlled trials, published in any language, that compared fluvoxamine with any other active antidepressants in the acute phase treatment of major depression. Data collection and analysis Two independent review authors inspected citations and abstracts, obtained papers, extracted data and assessed the risk of bias of included studies. We analysed dichotomous data using odds ratios (ORs) and continuous data using the standardised mean difference (SMD). A random effects model was used to combine studies. Main results A total of 54 randomised controlled trials (n = 5122) were included. No strong evidence was found to indicate that fluvoxamine was either superior or inferior to other antidepressants regarding response, remission and tolerability. However, differing side effect profiles were evident, especially with regard to gastrointestinal side effects of fluvoxamine when compared to other antidepressants. For example, fluvoxamine was generally associated with a higher incidence of vomiting/nausea (versus imipramine, OR 2.23, CI 1.59 to 3.14; versus clomipramine, OR 2.13, CI 1.06 to 4.27; versus amitriptyline, OR 2.86, CI 1.31 to 2.63). Authors’ conclusions We found no strong evidence that fluvoxamine was either superior or inferior to any other antidepressants in terms of efficacy and tolerability in the acute phase treatment of depression. However, differing side effect profiles were evident. Based on these findings, we conclude that clinicians should focus on practical or clinically relevant considerations, including these differences in side effect profiles.

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A double-blind comparison of paroxetine and fluvoxamine in major depression

Cited by 9 publications

References 0 publications

Selective serotonin reuptake inhibitors in affective disorders -II. Efficacy and quality of life

Selective serotonin reuptake inhibitors in affective disorders -II. Efficacy and quality of life

The efficacy of selective serotonin re-uptake inhibitors in depression: a meta-analysis of studies against tricyclic antidepressants

Fluvoxamine versus other anti-depressive agents for depression

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