Fluoxetine, a Selective Serotonin Uptake Inhibitor, for the Treatment of Outpatients with Major Depression

Byerley, William; Reimherr, Frederick W.; Wood, D.; Grosser, Bernard I.

doi:10.1097/00004714-198804000-00005

Cited by 67 publications

(26 citation statements)

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“…Our search identified 1707 studies, and an additional 4 studies were identified in references of other included trials and meta-analyses in the area. Forty studies met our inclusion criteria (17–55). The included studies reported 49 active treatment arms involving 10,039 adult patients with MDD.…”

Section: Resultsmentioning

confidence: 99%

“…The supplementary table depicts the characteristics of the included studies. Six different SSRIs were studied in placebo-controlled trials with major depressive disorder: fluoxetine (k=9, n= 2386) (17, 21, 29, 31, 46, 47, 49, 51, 56), fluvoxamine (k=8, n=910)(18, 24, 27, 38, 39, 42, 45, 54), paroxetine (k=16, n=3424)(19, 20, 22, 23, 25, 26, 28, 30, 33, 34, 36, 44, 48, 52, 55), sertraline (k=3, n=865)(43, 50, 57), citalopram (k=4, n=1349)(32, 37, 40, 50), and escitalopram (k=3, n=1105)(37, 41, 53). …”

Section: Resultsmentioning

confidence: 99%

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Systematic Review and Meta-Analysis: Dose-Response Relationship of Selective Serotonin Reuptake Inhibitors in Major Depressive Disorder

Jakubovski

Varigonda

Freemantle

et al. 2016

AJP

168

112

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Objective Previous studies suggested that the treatment response to Selective-Serotonin Reuptake Inhibitors (SSRIs) in Major Depressive Disorder (MDD) follows a flat response curve within the therapeutic dose range. Our study was designed to clarify the relationship between dosage and treatment response in MDD. Methods We searched PubMed for randomized placebo-controlled trials examining the efficacy of SSRIs for treating adults with MDD. Trials were also required to assess improvement in depression severity at multiple time points. Additional data was collected on treatment response and all cause and side effect-related discontinuation. All medication doses were transformed into imipramine equivalent doses. The longitudinal data was analyzed with a mixed regression model. Endpoint and tolerability analyses were analyzed using meta-regression and stratified subgroup analysis by predefined SSRI dose categories in order to assess the effect of SSRI dosing on the efficacy and tolerability of SSRIs for MDD. Results We included 40 studies involving 10,039 participants.. Longitudinal modeling [dose × time interaction=0.0007(95%CI:0.0001–0.0013;p=0.0196)] and endpoint analysis (meta-regression β=0.00053,95%CI:0.00018–0.00088,z=2.98,p=0.0029) demonstrated a small, but statistically significant positive association between SSRI dose and efficacy. Higher doses of SSRIs were associated with an increased likelihood of dropouts due to side-effects (meta-regression β=0.00207,95%CI:0.00071–0.00342,z=2.98,p=0.003) and decreased likelihood of all-cause dropout (meta-regression β=−0.00093,95% CI−0.00165–(−0.00021),z=−2.54,p=0.01). Conclusions Higher doses of SSRIs appear slightly more effective in MDD. This benefit appears to plateau around 250mg of imipramine equivalents (50mg of fluoxetine). The slightly increased benefits of SSRIs at higher doses are somewhat offset by decreased tolerability at high doses.

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Section: Resultsmentioning

confidence: 99%

Section: Resultsmentioning

confidence: 99%

Systematic Review and Meta-Analysis: Dose-Response Relationship of Selective Serotonin Reuptake Inhibitors in Major Depressive Disorder

Jakubovski

Varigonda

Freemantle

et al. 2016

AJP

168

112

View full text Add to dashboard Cite

show abstract

“…2 Clinical response should be assessed at 4-week intervals, and if the child has tolerated the antidepressant, the dose may be increased if a complete response has not been obtained. 10,11 At each step, adequate time should be allowed for clinical response, and frequent, early dose adjustments should be avoided. Furthermore, more than three-quarters of the treatment gains observed in adult SSRI trials are evident within the first month of treatment.…”

Section: Introductionmentioning

confidence: 99%

Systematic Review and Meta-Analysis: Early Treatment Responses of Selective Serotonin Reuptake Inhibitors in Pediatric Major Depressive Disorder

Varigonda

Jakubovski²,

Taylor

et al. 2015

Journal of the American Academy of Child & Adolescent Psych

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“…Trial 25 yielded a non-significant, 1.6-point HRSD advantage of placebo over fluoxetine. For example, Byerley et al (1988) reported results from a study site where fluoxetine was three times more effective, relative to placebo, than the combined multi-site results. Data from Trial 27, conducted at six study sites, were published in four separate articles.…”

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confidence: 99%

Is the Efficacy of “Antidepressant” Medications Overrated?

Deacon¹,

Spielmans²

2017

Psychological Science Under Scrutiny

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Fluoxetine, a Selective Serotonin Uptake Inhibitor, for the Treatment of Outpatients with Major Depression

Cited by 67 publications

References 0 publications

Systematic Review and Meta-Analysis: Dose-Response Relationship of Selective Serotonin Reuptake Inhibitors in Major Depressive Disorder

Systematic Review and Meta-Analysis: Dose-Response Relationship of Selective Serotonin Reuptake Inhibitors in Major Depressive Disorder

Systematic Review and Meta-Analysis: Early Treatment Responses of Selective Serotonin Reuptake Inhibitors in Pediatric Major Depressive Disorder

Is the Efficacy of “Antidepressant” Medications Overrated?

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