In older people with major depression, duloxetine, paroxetine, and sertraline each reduce depression symptoms

Thorlund K, Druyts E, Wu P, et al. Comparative efficacy and safety of selective serotonin reuptake inhibitors and serotonin-norepinephrine reuptake inhibitors in older adults: a network meta-analysis. J Am Geriatr Soc. 2015;63:1002-9.

Review questions

In older adults with major depression, which drugs are best for reducing depression symptoms? Are some drugs worse than others for side effects such as dizziness, vertigo (dizziness with feelings of spinning), syncope (fainting), loss of consciousness, and falls?

Background

Depression is a common mood disorder that affects how you feel, think, and behave. It is an important mental health issue for older people. Symptoms of depression (e.g., feeling sad, losing interest in things you like to do, having trouble thinking or concentrating, feeling anxious or restless) can be severe and persist (major depression) or milder.

Depression is more than just being sad and may get worse if not treated. There are many treatments for depression, both without drugs and with drugs. This review is about drugs that have been tested among older people. The types of drugs reviewed are serotonin- and norepinephrine-reuptake inhibitors (SNRIs) and selective serotonin-reuptake inhibitors (SSRIs).

How the review was done

The researchers did a systematic review, searching for studies that were published up to December 2013.

They found 15 randomized controlled trials with 4,588 people (average age 67 to 80 years, 62% women).

The key features of the studies were:

• people were 60 years of age or older and had major depression;
• drugs were SNRIs (duloxetine or venlafaxine) or SSRIs (citalopram, escitalopram, fluoxetine, paroxetine, or sertraline);
• drugs were compared with placebo or with one another; and
• people were treated for at least 6 weeks—most were treated for 6 to 8 weeks.

What the researchers found

For reducing symptoms of depression:

• duloxetine was better than placebo, fluoxetine, escitalopram, or citalopram;
• paroxetine was better than placebo, fluoxetine, or escitalopram;
• sertraline was better than placebo; and
• other drugs were similar to placebo or each other.

For causing dizziness:

• venlafaxine was worse than placebo, sertraline, or fluoxetine; and
• duloxetine was worse than placebo.

There was not enough information about other side effects of the drugs.

Conclusions

In older people with major depression, duloxetine, paroxetine, and sertraline each reduce depression symptoms more than placebo. Duloxetine and paroxetine each reduce depression symptoms more than fluoxetine or escitalopram.

SNRI and SSRI drugs for treating major depression in older adults

SNRI = serotonin- and norepinephrine-reuptake inhibitor; SSRI = selective serotonin-reuptake inhibitor.

*Trials were combined using a type of analysis that lets you compare treatments even if they were not compared directly in the individual trials.