Song and colleagues published the first meta-analysis comparing SSRIs with TCAs. They examined efficacy and discontinuation rates and found no difference between the two drug classes. That study, however, was complicated by the use of a variety of different definitions for response and by the inclusion ofatypical agents (eg, bicyclics) in the analysis along with the TCAs. On the other hand, the meta-analysis conducted by Moller and associates compared imipramine with newer agents including SSRIs and atypical agents, which were pooled despite differences in chemical classes. As with the former analysis by Song et al, groups had similar efficacies. Those results are similar to those that we found in that differences among groups were not statistically significant. asthma inhalers
The SSRIs were the focus of the meta-analysis by Montgomery et al , who compared dropout rates due to ADRs in 42 studies. They found that significantly fewer SSRI users (14.9%) dropped out due to ADRs than did patients taking TCAs (19%). In a follow-up study, Montgomery and Kasper updated their previous meta-analysis by analyzing 67 clinical trials. Results remained the same, with a statistically significant difference (P<0.05) of 4.5% in favour of SSRIs. In the present study, we found ADR dropout rates of 17.9% for SSRIs and 26.6% for TCAs, which are similar but slightly higher than those found by Montgomery et al . Klawansky conducted a series of meta-analyses that examined antidepressant use in the elderly population. SSRIs (fluoxetine) had a total dropout rate that was 10.7% lower than that of TCAs, but the difference was not statistically significant. Anderson and Tomenson found a 10% difference between rates of discontinuation for SSRIs and those for TCAs – similar to the difference of 8.7% found in the present study.