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Predictive value of pharmacological activity for the relative efficacy of antidepressant drugs

Meta-regression analysis

Medicines Evaluation Group, Centre for Health Economics, University of York

I. M. ANDERSON, MD

University of Manchester, Department of Psychiatry

P. YOUNG, PhD

Department of Health Science & Clinical Evaluation, University of York

Correspondence: Nick Freemantle, Reader in Epidemiology & Biostatistics, Medicines Evaluation Group, Centre for Health Economics, University of York, Heslington, York YO10 5DD, UK. Tel: 01904 434568; fax: 01904 433640; e-mail: meg{at}york.ac.uk

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.

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.

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