SynthesisAnnals of family medicine
Efficacy and tolerability of tricyclic antidepressants and SSRIs compared with placebo for treatment of depression in primary care: a meta-analysis.
Synthesis in Annals of family medicine. The graph could read no effect estimate from its abstract, so it casts no vote on the map. Cited by 112 papers, 13 of them syntheses that pooled it.
What it found
Each row is one number read from the abstract, on the scale the paper reported it, with its interval. Left of the dashed line favours the treatment, right favours the comparator. Under each row is the sentence it came from. New to these charts? A ten-minute tutorial.
The abstract states no effect estimate the extractor could read, or names no intervention and outcome on the map, so this paper lights no cell and moves no belief. It is still indexed, cited and linked below.
The trial behind it
Trials whose registry record cites this paper, or whose number appears in the abstract. A trial that started after this paper was published is citing it as background, not reporting it.
Neither the registry nor the abstract names a trial number. If this is a trial report, that itself is worth knowing.
Who cites it
112 citing papers in PubMed, 13 syntheses or guidelines pooled it, 353 citations in OpenAlex.
- Beneficial and harmful effects of tricyclic antidepressants for adults with major depressive disorder: a systematic review with meta-analysis and trial sequential analysis.BMJ mental health · 2024Pooled it
- Pooled it
- Guidelines for the pharmacological acute treatment of major depression: conflicts with current evidence as demonstrated with the German S3-guidelines.BMC psychiatry · 2019Pooled it
- Use of antidepressants and the risk of cardiovascular and cerebrovascular disease: a meta-analysis of observational studies.European journal of clinical pharmacology · 2017Pooled it
- Systematic review of interventions for depression and anxiety in persons with inflammatory bowel disease.BMC research notes · 2016Pooled it
- Antidepressant treatment for postnatal depression.The Cochrane database of systematic reviews · 2014Pooled it
- [Antidepressants for treatment of depression in palliative patients : a systematic literature review].Schmerz (Berlin, Germany) · 2012Pooled it
- Mirtazapine versus other antidepressive agents for depression.The Cochrane database of systematic reviews · 2011Pooled it
- Depression in adults: drug and physical treatments.BMJ clinical evidence · 2011Pooled it
- Antidepressants versus placebo for depression in primary care.The Cochrane database of systematic reviews · 2009Pooled it
- Milnacipran versus other antidepressive agents for depression.The Cochrane database of systematic reviews · 2009Pooled it
- Depression in adults: drug and physical treatments.BMJ clinical evidence · 2007Pooled it
- Efficacy and acceptability of pharmacological treatments for depressive disorders in primary care: systematic review and network meta-analysis.Annals of family medicinePooled it
- A randomized, double-blind, placebo-controlled, dose-ranging study of lisdexamfetamine dimesylate augmentation for major depressive disorder in adults with inadequate response to antidepressant therapy.Journal of psychopharmacology (Oxford, England) · 2017Trial
- Randomized Clinical Trial of Real-Time fMRI Amygdala Neurofeedback for Major Depressive Disorder: Effects on Symptoms and Autobiographical Memory Recall.The American journal of psychiatry · 2017Trial
- Efficacy and safety of escitalopram in treatment of severe depression in Chinese population.Metabolic brain disease · 2017Trial
- Acupuncture treatment modulates the corticostriatal reward circuitry in major depressive disorder.Journal of psychiatric research · 2017Trial
- Repeated acupuncture treatments modulate amygdala resting state functional connectivity of depressive patients.NeuroImage. Clinical · 2016Trial
- Effect of low-dose acute tryptophan depletion on the specificity of autobiographical memory in healthy subjects with a family history of depression.Psychopharmacology · 2012Trial
- Dense cranial electroacupuncture stimulation for major depressive disorder--a single-blind, randomized, controlled study.PloS one · 2012Trial
52 more citing papers are in PubMed but not listed here.
Corrections and comments
PubMed lists nothing against this paper. Absence here is not a guarantee, only a check that was made.
Authors and funding
7 authors at 1 institution in 1 country.
Funding
No grant is acknowledged in the PubMed record.
Abstract
purposeDepression is common in primary care. There are no systematic reviews of depression treatment comparing antidepressants with placebo; hence, we do not know whether these medications are effective in primary care.
methodsWe searched the Cochrane Collaboration Depression, Anxiety and Neurosis Group register of controlled trials, MEDLINE, International Pharmaceutical abstracts, PsycINFO, and EMBASE. Abstracts of potential studies were reviewed independently by 2 authors. Studies needed to include randomized controlled trials of either a tricyclic antidepressant (TCA) or selective serotonin reuptake inhibitor (SSRI), or both, and placebo in a primary care setting. The data and quality of the studies were extracted and assessed by 2 authors blind to the other's choice. Disagreements were resolved by discussion. The main outcome measures were the standardized mean difference and weighted mean difference of the final mean depression scores, the relative risk of improvement, and the number withdrawing because of side effects. Pooling of results was done using Review Manager 4.2.2.
resultsThere were 10 studies in which TCAs were compared with placebo, 3 in which SSRIs were compared with placebo, and 2 with both compared with placebo. One half of the studies were of low methodological quality, and nearly all studies were of short duration, typically 6 to 8 weeks. Pooled estimates of efficacy data showed a relative risk of 1.26 (95% CI, 1.12-1.42) for improvement with TCAs compared with placebo; For SSRIs, relative risk was 1.37 (95% CI, 1.21-1.55). Most patients, 56% to 60%, responded well to active treatment compared with 42% to 47% for placebo. The number needed to treat for TCAs was about 4, and for SSRIs it was 6. The numbers needed to harm (for withdrawal caused by side effects) ranged from 5 to 11 for TCAs and 21 to 94 for SSRIs. Low-dose (100 mg or 75 mg) as well as high-dose TCAs were effective.
conclusionThis systematic review is the first comparing antidepressants with placebo for treatment of depression in primary care. Both TCAs and SSRIs are effective. This review is also the first to show that low-dose TCAs are effective in primary care. Prescribing antidepressants in primary care is a more effective clinical activity than prescribing placebo.
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Registered trials
Read under generation 80e0d062 · epoch 390. Bibliography from PubMed, PubMed Central and OpenAlex; grants from NIH RePORTER; trial links from ClinicalTrials.gov; estimates, votes and beliefs from the OpenQuestion graph.