Risks of Digestive System Side-Effects of Selective Serotonin Reuptake Inhibitors in Patients with Depression: A Network Meta-Analysis

Abstract

Purpose Selective serotonin reuptake inhibitors (SSRIs) are the preferred treatments for depression. The most common adverse drug reactions are symptoms involving the digestive system, leading to low compliance in patients with depression. Therefore, it is important to assess the safety of SSRIs with respect to the digestive system. Several meta-analyses have compared the risks of digestive side effects of SSRIs and other antidepressants. We aimed to compare the risks of various SSRIs (fluoxetine, escitalopram, citalopram, paroxetine, and sertraline) for adverse reactions of the digestive system. Methods Systematic searches returned 30 randomized controlled trials (n = 5004) of five antidepressants and placebos. Results Fluoxetine had the lowest probability of digestive side effects, ranking fifth at 0.548. Sertraline had the highest probability of digestive side effects, with a probability of 0.611. For gastrointestinal tolerability, escitalopram was better than paroxetine (odds ratio [OR] =0.62, 95% confidence interval [CI] 0.43–0.87) and sertraline (OR=0.56, 95% CI 0.32–0.99). Conclusion Fluoxetine exhibited distinct advantages compared to other SSRIs, while sertraline had the greatest likelihood of digestive system side effects. These findings will help doctors understand the relative advantages of various antidepressants.

Exploring the transformative impact of traditional Chinese medicine on depression: Insights from animal models

“…Medication may be administered if the patient's condition does not improve. The effectiveness of selective serotonin reuptake inhibitors (SSRIs) such as fluoxetine, paroxetine, and sertraline for this aim is diminished by their potentially harmful side effects[ 5 ]. Despite the advancements in conventional treatments, the prevalence of depression and the limitations of existing interventions have led to exploring complementary and alternative approaches, such as traditional Chinese medicine (TCM)[ 6 ].…”

Incidence of adverse events and comparative tolerability of selective serotonin reuptake inhibitors, and serotonin and norepinephrine reuptake inhibitors for the treatment of anxiety, obsessive-compulsive, and stress disorders: a systematic review and network meta-analysis

“…Previous meta-analyses assessed the tolerability of SSRIs and SNRIs in the treatment of non-depressive disorders, but three key questions remain unanswered. First, previous studies restricted their inclusion criteria to specific medications (Li et al, 2018, 2020; Li, Zhu, Su, & Fang, 2017; Liu et al, 2018; Zhang et al, 2020), diagnoses (Li et al, 2020, 2017, 2018; Liu et al, 2018; Zhang et al, 2020), adverse events (Telang, Walton, Olten, & Bloch, 2018; Wang et al, 2022), or populations (Schwartz, Barican, Yung, Zheng, & Waddell, 2019). Thus, no large-scale quantitative review or network meta-analysis evaluated the comparative tolerability and rates of most adverse events associated with all SSRIs and SNRIS for the treatment of anxiety, obsessive-compulsive, and stress-related disorders.…”

Astragaloside IV Alleviates Depression in Rats by Modulating Intestinal Microbiota, T-Immune Balance, and Metabolome

“…Immune imbalance in intestine is mainly characterized by damage of immune cells, i.e., impaired secretion of T-helper 17 cells (Th17 cells), regulatory T cells (Treg cells), and cytokines, leading to inflammation, which in turn exacerbates gastrointestinal reactions such as inflammatory reactions caused by depression . Currently, studies have shown that AS-IV can modulate intestinal immune imbalances, such as the ratio of Th17/Treg cells, and the levels of immune factors . On top of the information mentioned above, herein, the Th17/Treg ratio and the expression of various cytokines were determined to demonstrate the mechanisms underlying antidepression effects of AS-IV from the perspective of immune balance of intestine.…”

“…18 Currently, studies have shown that AS-IV can modulate intestinal immune imbalances, such as the ratio of Th17/Treg cells, and the levels of immune factors. 19 On top of the information mentioned above, herein, the Th17/Treg ratio and the expression of various cytokines were determined to demonstrate the mechanisms underlying antidepression effects of AS-IV from the perspective of immune balance of intestine. Besides, related metabolites are effective contributors to the involvement of intestinal microbes in depression.…”