Predictive value of pharmacological activity for the relative efficacy of antidepressant drugs: Meta-regression analysis

Abstract

Background: There is uncertainty about the contribution of specific pharmacological properties to the efficacy of antidepressants. Aims: To assess whether specific pharmacological characteristics of alternative antidepressants resulted in altered efficacy compared to that of selective serotonin reuptake inhibitors in the treatment of major depression. Method: Meta-regression analysis of randomised trials that compare treatment with a selective serotonin reuptake inhibitor and an alternative antidepressant. Results: One-hundred-and-five randomised trials were included. None of the factors identified a priori predicted a statistically significant improvement in outcome across the trials. Conclusions: This analysis does not provide evidence that antidepressants acting at more than one pharmacological site differ in efficacy from drugs selective for serotonin reuptake in the treatment of major depression. Declaration of interest: Study sponsored by an unrestricted grant from Wyeth Laboratories. N.F. has previously received funding from the Department of Health to investigate the effectiveness and cost-effectiveness of antidepressants. I.M.A. has received research funding and honoraria from a number of pharmaceutical companies.