Five RCTs (1,434 patients) appear to have been included.
Sertraline (50 to 100 mg) versus placebo (1 RCT, 748 patients): sertraline significantly improved depression at 8 weeks compared with placebo. The mean decrease from the baseline HDRS was 7.7 with sertraline versus 6.5 with placebo (P<0.01). The response rates (CGI improved by 1 or 2 from baseline) were 46 and 35% with sertraline and placebo, respectively (P<0.01). The values quoted in the review were taken from a graph.
Sertraline (50 to 100 mg) versus fluoxetine (1 RCT, 236 patients): there was no significant difference between sertraline and fluoxetine in depression at 12 weeks in terms of the HDRS score, response rates, quality of life, CGI Severity, CGI Improvement, CGI Efficacy Index rating, MADRS or POMS. The mean decrease from the baseline HDRS was 11.3 with both sertraline and fluoxetine. The response rates (at least 50% decrease in HDRS from baseline) were 73 and 71% with sertraline and fluoxetine, respectively.
Sertraline (50 to 150 mg) versus nortriptyline (1 RCT, 210 patients): there was no significant difference between sertraline and nortriptyline at 12 weeks in terms of the HDRS score, response rates, CGI Severity, CGI Efficacy Index rating or Global Satisfaction. However, sertraline significantly improved some aspects of quality of life compared with nortriptyline: physical health (P=0.01), psychosocial health (P=0.01), leisure time satisfaction (P=0.02) and social health satisfaction (P=0.004). The mean decrease from the baseline HDRS was 14.4 with sertraline versus 13.0 with nortriptyline. The response rates (not defined) were 72 and 61% with sertraline and nortriptyline, respectively.
Sertraline (50 to 200 mg) versus amitriptyline (1 RCT, 185 patients): there was no significant difference between sertraline and amitriptyline at 8 weeks in terms of the HDRS score or response rates when using data from evaluable patients. An intention-to-treat analysis found that amitriptyline was significantly better when using the HDRS score (P value not reported). The mean decrease from the baseline HDRS was 13.3 with sertraline versus 14.2 with amitriptyline. The response rates (not defined) were 69 and 63% with sertraline and amitriptyline, respectively.
Sertraline (50 mg) versus imipramine (1 RCT, 55 patients): there was no significant difference between sertraline and imipramine in depression at 8 weeks, response rates or MADRS. The mean decrease from the baseline MADRS was 14.4 with sertraline versus 12.8 with imipramine. The response rates (at least 50% decrease in HDRS from baseline) were 56 and 61% with sertraline and imipramine, respectively.
Adverse reactions (percentages taken from graph, hence approximate).
Nortriptyline (1 RCT) and amitriptyline (1 RCT) significantly increased constipation and dry mouth compared with sertraline: constipation was approximately 40% with nortriptyline versus 10% with sertraline, while dry mouth was 78% with nortriptyline versus 40% with sertraline (P<0.001). Sertraline significantly increased nausea compared with both nortriptyline and amitriptyline: approximately 24% with sertraline versus 12% with nortriptyline (P<0.5).