Hostname: page-component-68945f75b7-z8dg2 Total loading time: 0 Render date: 2024-08-05T23:20:50.297Z Has data issue: false hasContentIssue false
  • English
  • Français

A meta-analysis of clinical trials comparing the serotonin (5HT)-2 receptor antagonists trazodone and nefazodone with selective serotonin reuptake inhibitors for the treatment of major depressive disorder

Published online by Cambridge University Press:  05 April 2007

George I. Papakostas  and
Maurizio Fava
George I. Papakostas*
Affiliation:
Department of Psychiatry, Depression Clinical and Research Program, Massachusetts General Hospital, Harvard Medical School, 15 Parkman Street, WAC 812, Boston, MA02114, USA
Maurizio Fava
Affiliation:
Department of Psychiatry, Depression Clinical and Research Program, Massachusetts General Hospital, Harvard Medical School, 15 Parkman Street, WAC 812, Boston, MA02114, USA
*
∗Corresponding author. Tel.: +617 724 6697; fax: +617 726 7541. E-mail address: gpapakostas@partners.org (G.I. Papakostas).
Get access

Abstract

Objective

To compare response rates among patients with major depressive disorder (MDD) treated with either a serotonin-2 (5HT2-) receptor antagonist or a selective serotonin reuptake inhibitor (SSRI).

Methods

Medline and PubMed were searched for double-blind, randomized clinical trials comparing either trazodone or nefazodone with an SSRI for the treatment of MDD. Data from 9 reports involving a total 988 patients were identified and combined using a random-effects model.

Results

Patients randomized to treatment with a 5HT2 antagonist were as likely to experience clinical response as patients randomized to treatment with an SSRI (RR = 1.002, 95% CI: 0.85–1.17, P = 0.978). Pooled response rates for trazodone/nefazodone and the SSRis were 61.1% and 61.7%, respectively. There was also no difference in overall discontinuation rates (P = 0.334), discontinuation due to adverse events (P = 0.676), or discontinuation due to inefficacy (P = 0.289) between the two groups.

Conclusions

These results suggest that the 5HT2-receptor antagonists trazodone and nefazodone and the SSRis do not differ with respect to their overall efficacy and tolerability in the treatment of MDD. Although the sample size was relatively large and conveyed sufficient statistical power to test for differences in the overall sample, depression is a heterogeneous condition and differences may exist between treatments in particular subgroups of patients.

Keywords

5HT2SSRITrazodoneNefazodoneDepression
Type
Original article
Information
European Psychiatry , Volume 22 , Issue 7 , October 2007 , pp. 444 - 447
Copyright
Copyright © Elsevier Masson SAS 2007

Access options

Get access to the full version of this content by using one of the access options below. (Log in options will check for institutional or personal access. Content may require purchase if you do not have access.)

References

anderson, I.M.Selective serotonin reuptake inhibitors versus tricyclic antidepressants: a meta-analysis of efficacy and tolerability. J Affect Disord 2000;58(1):19–36.CrossRefGoogle ScholarPubMed
Armitage, R., Yonkers, K., Cole, D., Rush, A.J.A multicenter, double-blind comparison of the effects of nefazodone and fluoxetine on sleep architecture and quality of sleep in depressed outpatients. J Clin Psychopharmacol 1997;17(3):161–168.CrossRefGoogle ScholarPubMed
Avila, A., Cardona, X., Martin-Baranera, M., Maho, P., Sastre, F., Bello, J.Does nefazodone improve both depression and Parkinson disease? A pilot randomized trial. J Clin Psychopharmacol 2003;23(5):509–513.CrossRefGoogle ScholarPubMed
Baldwin, D.S., Hawley, C.J., Abed, R.T., Maragakis, B.P., Cox, J., Buckingham, S.A.et al.A multicenter double-blind comparison of nefazodone and paroxetine in the treatment of outpatients with moderate-to-severe depression. J Clin Psychiatry 1996;57s(2):46–52.Google Scholar
Beasley, C.M. Jr., Dornseif, B.E., Pultz, J.A., Bosomworth, J.C., Sayler, M.E.Fluoxetine versus trazodone: efficacy and activating-sedating effects. J Clin Psychiatry 1991;52(7):294–299.Google ScholarPubMed
Berlanga, C., Arechevaleta, B., Heinze, G.A double-blind comparison of nefazodone and fluoxetine in the treatment of depressed outpatients. Salud Mental 1997;20:1–8.Google Scholar
Debus, J.R., Rush, A.J., Himmel, C., Tyler, D., Polatin, P., Weissenburger, J.Fluoxetine versus trazodone in the treatment of outpatients with major depression. J Clin Psychiatry 1988;49(11):422–426.Google ScholarPubMed
DerSimonian, R., Laird, N.Meta-analysis in clinical trials. Control Clin Trials 1986;7:177–188.CrossRefGoogle ScholarPubMed
Falk, W.E., Rosenbaum, J.F., Otto, M.W., Zusky, P.M., Weilburg, J.B., Nixon, R.A.Fluoxetine versus trazodone in depressed geriatric patients. J Geriatr Psychiatry Neurol 1989;2(4):208–214.Google ScholarPubMed
Feiger, A., Kiev, A., Shrivastava, R.K., Wisselink, P.G., Wilcox, C.S.Nefazodone versus sertraline in outpatients with major depression: focus on efficacy, tolerability, and effects on sexual function and satisfaction. J Clin Psychiatry 1996;57s(2):53–62.Google Scholar
Ferguson, J.M., Shrivastava, R.K., Stahl, S.M., Hartford, J.T., Borian, F., Ieni, J.et al.Reemergence of sexual dysfunction in patients with major depressive disorder: double-blind comparison of nefazodone and sertraline. J Clin Psychiatry 2001;62(1):24–29.CrossRefGoogle ScholarPubMed
Fudge, J.L., Perry, P.J., Garvey, M.J., Kelly, M.W.A comparison of the effect of fluoxetine and trazodone on the cognitive functioning of depressed outpatients. J Affect Disord 1990;18(4):275–280.CrossRefGoogle ScholarPubMed
Gillin, J.C., Rapaport, M., Erman, M.K., Winokur, A., Albala, B.J.A comparison of nefazodone and fluoxetine on mood and on objective, subjective, and clinician-rated measures of sleep in depressed patients: a double-blind, 8-week clinical trial. J Clin Psychiatry 1997;58(5):185–192.CrossRefGoogle ScholarPubMed
in: Guy, W.ECDEU Assessment manual for psychopharmacology, revised Rockville, MD: National institute of Mental Health; DHEW Pub. No. (ADM) 76–338.Google Scholar
Hamilton, M.A rating scale for depression. J Neurol Neurosurg Psychiatry 1960;23:1976. p. 56–62.CrossRefGoogle ScholarPubMed
Hicks, J.A., Argyropoulos, S.V., Rich, A.S., Nash, J.R., Bell, C.J., Edwards, C.et al.Randomised controlled study of sleep after nefazodone or paroxetine treatment in out-patients with depression. Br J Psychiatry 2002;180:528–535.CrossRefGoogle ScholarPubMed
Kasper, S., Olie, J.P.A meta-analysis of randomized controlled trials of tianeptine versus SSRI in the short-term treatment of depression. Eur Psychiatry 2002;17(Suppl. 3):331–340.CrossRefGoogle ScholarPubMed
Kasper, S., Olivieri, L., Di Loreto, G., Dionisio, P.A comparative, randomised, double-blind study of trazodone prolonged-release and paroxetine in the treatment of patients with major depressive disorder. Curr Med Res Opin 2005;21(8):1139–1146.CrossRefGoogle ScholarPubMed
Laird, N.M., Mosteller, F.Some statistical methods for combining experimental results. int J Technol Assess Health Care 1990;6:5–30.CrossRefGoogle ScholarPubMed
Montgomery, S.A., Asberg, A.A new depression scale designed to be sensitive to change. Br J Psychiatry 1979;134:382–389.CrossRefGoogle ScholarPubMed
Mosteller, F., Colditz, G.A.Understanding research synthesis (meta-analysis). annu Rev Public Health 1996;17:1–23.CrossRefGoogle Scholar
Munizza, C., Olivieri, L., Di Loreto, G., Dionisio, P.A comparative, randomized, double-blind study of trazodone prolonged-release and sertraline in the treatment of major depressive disorder. Curr Med Res Opin 2006;22(9):1703–1713.CrossRefGoogle ScholarPubMed
Nelson, J.C.A review of the efficacy of serotonergic and noradrenergic reuptake inhibitors for treatment of major depression. Biol Psychiatry 1999;46(9):1301–1308.CrossRefGoogle ScholarPubMed
Papakostas, G.I., Fava, M.Monoamine-based pharmacotherapy. in: Licinio, J. editor. Biology of depression: from novel insights to therapeutic strategies 1st ed.Weinheim: Wiley-VCH; 2005. p. 87–140.CrossRefGoogle Scholar
Papakostas, G.I.Dopaminergic-based pharmacotherapies for depression. Eur Neuropsychopharmacol 2006;16(6):391–402.CrossRefGoogle ScholarPubMed
Papakostas, G.I., Fava, M.Does the probability of receiving placebo influence the likelihood of responding to placebo or clinical trial outcome? A meta-regression of double-blind, randomized clinical trials in MDD. Neuropsychopharmacology 2006;31(s1):s158.Google Scholar
Papakostas, G.I.Dopaminergic-based pharmacotherapies for depression. Eur Neuropsychopharmacol 2006;16(6):391–402.CrossRefGoogle ScholarPubMed
Papakostas, G.I., Fava, M.A meta-analysis of clinical trials comparing moclobemide with selective serotonin reuptake inhibitors for the treatment of major depressive disorder. Can J Psychiatry 2006;51(12):783–790.CrossRefGoogle ScholarPubMed
Papakostas, G.I., Homberger, C.H., Fava, M.A meta-analysis of clinical trials comparing mirtazapine with a selective serotonin reuptake inhibitor for the treatment of major depressive disorder. J Psychopharmacol, in press.Google Scholar
Perry, P.J., Garvey, M.J., Kelly, M.W., Cook, B.L., Dunner, F.J., Winokur, G.A comparative trial of fluoxetine versus trazodone in outpatients with major depression. J Clin Psychiatry 1989;50(8):290–294.Google ScholarPubMed
Petersen, T., Papakostas, G.I., Posternak, M.A., Kant, A., Guyker, W.M., Iosifescu, D.V.et al.Empirical testing of two models for staging antidepressant treatment resistance. J Clin Psychopharmacol 2005;25(4):336–341.CrossRefGoogle ScholarPubMed
Rush, A.J., Armitage, R., Gillin, J.C., Yonkers, K.A., Winokur, A., Moldofsky, H.et al.Comparative effects of nefazodone and fluoxetine on sleep in outpatients with major depressive disorder. Biol Psychiatry 1998;44(1):3–14.CrossRefGoogle ScholarPubMed
Sterne, J.A., Gavaghan, D., Egger, M.Publication and related bias in meta-analysis: power of statistical tests and prevalence in the literature. J Clin Epidemiol 2000;53(11):1119–1129.Google ScholarPubMed
Thase, M.E., Lu, Y., Joliat, M.J., Detke, M.J.Remission in placebo-controlled trials of duloxetine with an SSRI comparator. American Psychiatric Association annual Meeting; 2003.Google Scholar
Submit a response

Comments

No Comments have been published for this article.