Ten RCTs were included in the review (n=430). One RCT was reported in abstract form only. Results of the validity assessment were described narratively in appendices.
There were no significant differences between SSRIs and placebo for treatment response rate (RR 1.08, 95% CI 0.75 to 1.55; six RCTs). There were no significant differences between SSRIs and placebo for tolerability (RR 1.28, 95% CI 0.67 to 2.45; five RCTs). Sensitivity analyses of citalopram produced similar results.
Sensitivity analyses that included only the two citalopram studies, excluded two studies that used amitriptyline or rTMS and considered mean differences as a measurement for treatment response did not significantly alter the results. There was no evidence of statistical heterogeneity or publication bias for this analysis.
There were no significant differences between SSRIs and TCAs for treatment response rate (RR 0.75, 95% CI 0.39 to 1.42; three RCTs) and tolerability (RR 0.96, 95% CI 0.56 to 1.64; three RCTs).
Data on adverse effects were reported in the review.