Anderson I M, Tomenson B M
Department of Psychiatry, University of Manchester.
BMJ. 1995 Jun 3;310(6992):1433-8. doi: 10.1136/bmj.310.6992.1433.
To assess treatment discontinuation rates with selective serotonin reuptake inhibitors compared with tricyclic antidepressants.
Meta-analysis of 62 randomised controlled trials.
6029 patients with major unipolar depression.
Pooled risk ratios for drop out rates with respect to all cases of discontinuation and those due to side effects and treatment failure.
The total discontinuation rate was 10% lower with selective serotonin reuptake inhibitors than with tricyclic antidepressants (risk ratio 0.90; 95% confidence interval 0.84 to 0.97) and the drop out rate due to side effects was 25% lower (risk ratio 0.75; 0.66 to 0.84). There was no significant difference between drug classes in the drop out rates for treatment failure. The risk ratios for drop out did not differ significantly between individual selective serotonin reuptake inhibitors.
Selective serotonin reuptake inhibitors are better tolerated than tricyclic antidepressants as measured by total numbers of drop outs. The definite advantage to selective serotonin reuptake inhibitors is explained by fewer drop outs due to side effects. The overall difference, however, is comparatively small and may not be clinically relevant. Analyses of cost effectiveness should not overestimate the advantage to selective serotonin reuptake inhibitors.
评估与三环类抗抑郁药相比，选择性5-羟色胺再摄取抑制剂的治疗中断率。
对62项随机对照试验进行荟萃分析。
6029例重度单相抑郁症患者。
所有中断治疗病例、因副作用和治疗失败导致的中断治疗病例的汇总风险比。
与三环类抗抑郁药相比，选择性5-羟色胺再摄取抑制剂的总中断率低10%（风险比0.90；95%置信区间0.84至0.97），因副作用导致的退出率低25%（风险比0.75；0.66至0.84）。在因治疗失败导致的退出率方面，不同药物类别之间没有显著差异。各选择性5-羟色胺再摄取抑制剂之间的退出风险比没有显著差异。
以退出治疗的总人数衡量，选择性5-羟色胺再摄取抑制剂比三环类抗抑郁药耐受性更好。选择性5-羟色胺再摄取抑制剂的明确优势在于因副作用导致的退出治疗情况较少。然而，总体差异相对较小，可能在临床上并不相关。成本效益分析不应高估选择性5-羟色胺再摄取抑制剂的优势。
