2007 issue 4

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Volume 16, issue 4

Original article

SSRI and SNRI antidepressants in the treatment of old age depression: a systematic literature review and meta-analysis of randomized controlled trials

Tomasz Sobów1
1. Klinika Psychiatrii Wieku Podeszłego i Zaburzeń Psychotycznych Uniwersytetu Medycznego w Łodzi
Postępy Psychiatrii i Neurologii 2007; 16 (4): 281-290
Keywords: SSRI, SNRI, tricyclic antidepressants, depression, elderly, meta-analysis

Abstract

Aim. To assess efficacy and tolerability of modern antidepressants (SSRI and SNRI) in the treatment of depression in the elderly.

Methods. A systematic literature review with the use of electronic databases (Medline {Pubmed}, Cochrane, Embase and PsychInfo) was carried out. A meta-analysis of available studies have been conducted using Mantel-Haenszel method utilizing fixed model. We have compared two efficacy parameters (proportions of subjects achieving a 50% reduction of symptoms {response} or remission) and a basic parameter of safety, being a number of adverse effect leading to drug discontinuation.

Results. Thirteen randomized, controlled (with placebo or active control use) trials (RCT) evaluating the efficacy and tolerability of either SSRI or SNRI in the treatment of old age depression have been identified. Due to limited number of studies only two meta-analytic comparisons (SSRI versus placebo, and SSRI versus tricyclics) were possible to conduct. SSRI drugs as a group tended to be more efficacious though significantly less well tolerated than placebo. No advantage of one SSRI over another have been detected. The results of treatment with SSI are better in more severely depressed subjects. Venlafaxine (no data available with other SNRIs, milnacipran or duloxetine) have no advantage in efficacy over sertraline or citalopram being less well tolerated than the two SSRIs. Tricyclic antidepressants (TCA) are similarly efficacious and significantly less well tolerated than SSRIs in the treatment of old age depression.

Conclusions. Extrapolation of the results of trials conducted in younger populations to the elderly depressed may be seriously misleading. Contrary to younger populations analyzed, SNRIs and TCAs are not more efficacious than SSRIs in the treatment of old age depression. Moreover, large placebo effect observed in the treated elderly subjects leads to severe interpretation difficulties.

Address for correspondence:
Dr Tomasz Sobów
Klinika Psychiatrii Wieku Podeszłego i Zaburzeń Psychotycznych Uniwersytetu Medycznego
Centralny Szpital Kliniczny
ul. Czechosłowacka 8/10, 92-216 Łódź
e-mail: tmsobow@csk.umed.lodz.pl