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Discontinuation rates for selective serotonin reuptake inhibitors and other second-generation antidepressants in outpatients with major depressive disorder: a systematic review and meta-analysis

Gartlehner, Geralda; Hansen, Richard A.b; Carey, Timothy S.a; Lohr, Kathleen N.c; Gaynes, Bradley N.d; Randolph, Leah C.a

International Clinical Psychopharmacology: March 2005 - Volume 20 - Issue 2 - p 59-69

The present study aimed to systematically compare overall loss to follow-up, discontinuation rates because of adverse events and discontinuation rates because of a lack of efficacy in published studies assessing the efficacy and tolerability of selective serotonin reuptake inhibitors (SSRIs) compared to other second-generation antidepressants in treating outpatients with major depressive disorder (MDD). We searched MEDLINE, Embase, The Cochrane Library, PsychLit and the International Pharmaceutical Abstracts from 1980 to 2004 (April). Twenty double-blinded, randomized controlled trials met our eligibility criteria and compared SSRIs to other second-generation antidepressants in adult outpatients with MDD. Pooled relative risks of discontinuation rates because of (i) any reason (overall loss to follow-up), (ii) adverse events and (iii) a lack of efficacy did not differ substantially between SSRIs as a class and other second-generation antidepressants. Taking the similar efficacy of second-generation antidepressant into account, our findings suggest that clinicians can focus on other practically or clinically relevant considerations such as costs, differences in side-effect profiles, onset of action or aspects of health-related quality of life to tailor a treatment to an individual patient's needs.

aCecil G. Sheps Center for Health Services Research

bSchool of Pharmacy

cDepartment of Health Policy and Administration, School of Public Health

dDepartment of Psychiatry, School of Medicine, University of North Carolina, Chapel Hill, North Carolina, USA

Conflict of interest: This work was conducted under a subcontract from the Oregon Evidence-based Practice Center, which reviewed and approved this material before submission. None of the authors has any conflicts of interest in connection with the submitted article.

Correspondence and requests for reprints to Gerald Gartlehner, University of North Carolina at Chapel Hill, Sheps Center for Health Services Research, Chapel Hill, NC 27599, USA

Tel: +1919 9667102; fax: +1919 9663811; e-mail:

Received 28 November 2004 Accepted 9 December 2004

© 2005 Lippincott Williams & Wilkins, Inc.