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Discontinuation rates of SSRIs and tricyclic antidepressants: a meta-analysis and investigation of heterogeneity

Published online by Cambridge University Press:  03 January 2018

Matthew Hotopf ,
Rebecca Hardy  and
Glyn Lewis
Matthew Hotopf*
Affiliation:
Department of Psychological Medicine, King's College School of Medicine and Dentistry and Institute of Psychiatry
Rebecca Hardy
Affiliation:
Department of Epidemiology and Public Health, University College London Medical School, 119 Torrington Place, London WCIE 6BT
Glyn Lewis
Affiliation:
Division of Psychological Medicine, University of Wales College of Medicine, Heath Park, Cardiff CF4 4XN, Wales
*
Dr Matthew Hotopf, Department of Psychological Medicine, King's College School of Medicine and Dentistry and Institute of Psychiatry, 103 Denmark Hill, London SE5 8AZ
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Abstract

Background

Previous meta-analyses suggest that individuals treated with serotonin-specific reuptake inhibitors (SSRIs) in randomised controlled trials (RCTs) are less likely to discontinue treatment than those on tricyclic antidepressants. This metaanalysis investigates whether this is due to the frequent use in RCTs of older reference tricyclics (imipramine and amitriptyline), which may have worse side-effects than more recent compounds.

Methods

A meta-analysis of RCTs comparing tricyclic and heterocyclic antidepressants with SSRIs in the treatment of depression.

Results

The overall odds ratio of discontinuation on tricyclic/heterocyclic antidepressants compared with SSRIs was 0.86 (95% CI 0.78–0.94). The odds ratio for reference tricyclics was 0.82 95% CI 0.72–0.23), newer tricyclics 0.89 (95% CI 0.74–1.06), and heterocyclics 1.02 (95% CI 0.78–1.35). The pooled advantage of SSRIs over tricyclics was maintained whether the population studied consisted of younger adults or only the elderly. No differences in discontinuation rates were detected between the SSRIs.

Conclusions

The lower rate of discontinuation in patients on SSRIs may be due to the use of old tricyclics (which have worse side-effects) as reference compounds. The SSRIs do not show a statistically significant difference in discontinuation rates when compared with newer tricyclics or heterocyclics.

Type
Papers
Information
The British Journal of Psychiatry , Volume 170 , Issue 2 , February 1997 , pp. 120 - 127
Copyright
Copyright © 1997 The Royal College of Psychiatrists 

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