Study designs of evaluations included in the review
Double-blind, randomised controlled trials (RCTs) were eligible. The trials ranged in duration from 4 to 12 weeks.
Specific interventions included in the review
Studies comparing serotonergic and noradrenergic re-uptake inhibitors were eligible. The drug treatments were: the selective serotonergic drugs fluoxetine (20 to 80 mg), paroxetine (20 to 30 mg), sertraline (50 to 150 mg), fluvoxamine (100 to 300 mg), citalopram (40 to 60 mg) and zimelidine (200 mg); and the selective noradrenergic drugs lofepramine (70 to 210 mg), maprotiline (50 to 150 mg), desipramine (100 to 300 mg), nortryptyline (25 to 125 mg) and reboxetine (8 to 10 mg). Two studies also included a placebo arm. Studies of doxepin and bupropion were excluded.
Participants included in the review
Patients with nonpsychotic major depression or a similarly defined syndrome were eligible. Depression was defined according to American Psychiatric Association DSM-III or III-R criteria for major depression (in all but four studies), Feighner criteria, Kielholz/Poelinger criteria, and Newcastle criteria. The participants were mainly out-patients, although some studies included in-patients. All studies selected unipolar patients, bar one, which also included bipolar patients.
Outcomes assessed in the review
The inclusion criteria were not defined in terms of the outcomes. All but one study assessed change in the Hamilton Depression Rating Scale (HAMD) or the Montgomery-Asberg scale (MADRS). The most common method of defining response rates was a 50% improvement in the HAMD or the MADRS. Clinical Global Improvement or similar ratings were also used to define response.
How were decisions on the relevance of primary studies made?
The author does not state how the papers were selected for the review, or how many of the reviewers performed the selection.