Selective serotonin reuptake inhibitors in major depression disorder treatment: an umbrella review on systematic reviews

Abstract

Background

Major depressive disorder (MDD) is a common mental problem and one of the leading causes of disability worldwide. SSRIs are the most commonly prescribed types of antidepressants which are called Selective Serotonin Reuptake Inhibitors and used as a primary therapeutic intervention in MDD. This umbrella review aimed to assess the efficacy and tolerability of selected SSRIs.

Methods

A systematic review on systematic reviews based on meta-analysis was conducted for head-to-head comparisons on 6 antidepressants (fluoxetine, citalopram, escitalopram, sertraline, paroxetine, and fluvoxamine) as monotherapy in the acute-phase treatment for adults with MDD. The primary outcomes included response rate and remission rate. The secondary outcome was the withdrawal rate due to any cause. All articles published on 6 electronic databases, including PubMed, Embase, Scopus, Cochrane, Web of Science, and ProQuest, until 28 August 2018, were searched and analysed.

Results

Fifteen meta-analysis based systematic reviews finally met all the inclusion criteria and pre-defined outcomes were extracted. Regarding the remission rate and withdrawal rate, statistically, significant comparisons showed that escitalopram was the better choice.

Conclusion

The descriptive analysis of the included articles showed that generally, escitalopram was more effective than other defined SSRIs in terms of response rate, remission rate, and withdrawal rate.

Keypoints

• This work compiles evidence from multiple meta-analyses based on systematic reviews and provides a clearer picture for assessing the efficacy of SSRIs, clarify current gaps and direction of future research in this category of antidepressants.

• A minority of included articles attained the high-quality rank according to AMSTAR-2.

• The descriptive analysis of the included articles showed that generally, escitalopram was more effective than other defined SSRIs in terms of response rate, remission rate, and withdrawal rate.

Keywords:

• Systematic review
• selective serotonin reuptake inhibitors
• antidepressive agents
• major depressive disorder

Ethics approval and consent to participate

The Master thesis from which this umbrella review is a part was ethically approved by the Ethics Committee at the Shiraz University of Medical Sciences (IRAN). However, due to not including patient-level data, consent to participate is not applicable.

Author contributions

MGD, EK, AH, KK contributed to the conception and design of the study. MGD, EK, KK and MB determined the search strategy, conducted the systematic review of the databases, and read articles and agreed upon inclusion and exclusion of them. AH assisted in defining the outcomes. MGD, KK and EK wrote all related parts of the manuscript. All authors reviewed critically the manuscript and approved the final version of it.

Disclosure statement

The authors declare that they have no competing interests.

Data availability statement

The datasets used and analysed during the current study are available from the corresponding author on reasonable request.

Additional information

Funding

This research received no specific grant from any funding agency, commercial or not-for-profit sectors.