Pharmacological and combined interventions for the acute depressive episode: focus on efficacy and tolerability

Figures & data

Table 1 Summary of antidepressant classes and common brands

MAOIs	SSRIs	SNRIs	TCAs	Others
Tranylcypromine	Fluoxetine	Venlafaxine	Amitriptyline	Bupropion
Phenelzine	Paroxetine	Duloxetine	Clomipramine	Mirtazapine
Isocarboxazid	Sertraline	Milnacipran	Imipramine	Reboxetine
Transdermal selegine	Fluvoxamine	Desvenlafaxine	Nortriptyline	Trazodone
	Citalopram			Nefazodone
	Escitalopram

Abbreviations: TCAs, tricyclic antidepressants; MAOIs, monoamine oxidase inhibitors; SSRIs, selective serotonin reuptake inhibitors; SNRIs, serotonin-norepinephrine reuptake inhibitors.

Table 2 Summary of meta-analyses that compared antidepressants vs placebo

Author	Antidepressant	Condition	Studies (subjects)	Main results	Comments
Chen^Citation41	All	PSD	16 (1320)	ES = 0.23 for AD (response)	Longer treatments might be more effective
Nelson^Citation40	2nd gen	Geriatric	10 (4165)	ORs = 1.4 vs placebo (remission)	Significant heterogeneity of outcomes
Arroll^Citation43	All	Prim. care	15 (2753)	NNT = 4–6 vs placebo (remission)	Both TCA and SSRI were effective
Kirsch^Citation42	2nd gen (4 AD)	Adult	35 (5133)	d = 0.32 (mood score)	Included unpublished studies

Abbreviations: OR, odds ratio; RR, relative risk; ES, effect size; AD, antidepressants; NNT, number needed to treat; d, Cohen’s d (a measure of effect size); TCA, tricyclic antidepressants; SSRI, selective serotonin reuptake inhibitors PSD, post-stroke depression.

Table 3 Summary of meta-analyses that compared antidepressants vs “new” antidepressants

Author	Antidepressant	Studies (number of patients)	Main results	Comments
Hansen^Citation44	“New” AD	46 (N/A)	No difference in AD efficacy	Quantitative analyses were not done
Montgomery^Citation45	6 AD	N/A (N/A)	ESC probably superior	Not a systematic review
Cipriani^Citation33	2nd gen (12 AD)	117 (25928)	ESC and SERT superior	Direct/indirect comparisons

Notes: “New” AD refers to new antidepressants, such as selective serotonin reuptake inhibitors (SSRI).

Abbreviations: ESC, escitalopram; SERT, sertraline.

Table 4 Characteristics of each repetitive transcranial magnetic study (rTMS) study included

Author	Patients	Strategy	Antidepressant used	Main results
Rossini^Citation25	99	accelerating	Venlafaxine, escitalopram or sertraline	rTMS hastened response of all drugs
Rumi^Citation74	46	accelerating	Amitriptyline	rTMS hastened response of drug
Herwig^Citation75	127	accelerating	Mirtazapine or venlafaxine	active and sham groups showed similar response
Bretlau^Citation76	45	accelerating	Escitalopram	rTMS hastened response of drug
Su^Citation65	30	add-on	Various (TRD)	superior response rate in active group
Rossini^Citation66	50	add-on	Various (TRD)	superior response rate in the 100% MT group
Avery^Citation67	68	add-on	Various (TRD)	superior response rate in active group
Fitzgerald^Citation68	50	add-on	Various (TRD)	superior response rate in active group
Garcia-Toro^Citation69	30	add-on	Various (TRD)	superior response rate in both active groups
Anderson^Citation70	29	add-on	Various (TRD)	superior response rate in active group
Bortolomasi^Citation71	19	add-on	Various (TRD)	superior response rate in active group
Loo^Citation72	38	add-on	Various (TRD)	superior response rate in active group
Mogg^Citation73	59	add-on	Various (TRD)	no difference between groups

Notes: An “accelerating” strategy is when both interventions begin at the same time, to hasten a response. An add-on strategy is when rTMS is used as an augmentation strategy.

Abbreviation: TRD, treatment-resistant depression.

Table 5 Summary of common side effects related to use of antidepressants

Side effect	Drug	Side effect	Drug
Nausea/vomiting	Venlafaxine	Increase in blood pressure	Venlafaxine
Dizziness	Venlafaxine	Somnolence	Trazodone
Sexual side effects	Sertraline, paroxetine, mirtazapine	Discontinuation syndrome	Paroxetine, venlafaxine
Weight gain	Mirtazapine, paroxetine	Suicidal behavior	Not enough evidence
Headache	Bupropion	Serotonin syndrome	All antidepressants
Insomnia	Bupropion	Drop-out rates	Fluovoxamine, reboxetine

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