Selective serotonin reuptake inhibitors

Jan 1, 1994International clinical psychopharmacology

Discontinuation rates of selective serotonin reuptake inhibitors: a meta-analysis

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Abstract

Patients receiving SSRIs had a 14.9% discontinuation rate due to side effects, compared to 19% for those on TCAs.

Fewer patients discontinued SSRIs due to side effects than TCAs, with a statistically significant difference (p < 0.01).
In placebo-controlled studies, the discontinuation rate for side effects was 19% for SSRIs and 27% for TCAs (p < 0.01).
Discontinuation rates for lack of efficacy were similar between SSRIs and TCAs.
SSRIs show a significant advantage in treatment acceptability based on lower discontinuation due to side effects.
The overall risk-benefit analysis favors SSRIs due to comparable efficacy but lower discontinuation rates.

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A meta-analysis was carried out of 42 published randomized controlled studies comparing the selective serotonin reuptake inhibitors (SSRIs) with the tricyclic antidepressants (TCAs) that measured discontinuation rates for side effects and lack of efficacy by treatment group in order to compare the discontinuation rates for side effects and lack of efficacy. These discontinuation rates were pooled to produce the main outcome measure. Seven studies were placebo controlled and the discontinuation rates in these studies were also pooled in a separate analysis. Significantly fewer patients receiving SSRIs discontinued treatment because of side effects (14.9%) compared with those receiving TCAs (19%) (p < 0.01). There was also a significant difference in discontinuation rates due to side effects in the placebo- and TCA-controlled studies analysed separately, SSRIs (19%) compared with TCAs (27%) (p < 0.01). In both analyses a similar proportion of patients discontinued for lack of efficacy on SSRIs and TCAs. There is a significant and clinically important advantage for the SSRIs compared with the TCAs in the acceptability of treatment measured by the number of discontinuations due to side effects reported in published studies. The risk-benefit calculation favours the SSRIs since there were similar levels of efficacy but more discontinuations with the TCAs. The selection of an antidepressant for first-line treatment requires critical evaluation of the full risk-benefit equation.

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Selective serotonin reuptake inhibitors

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