Early onset of selective serotonin reuptake inhibitor antidepressant action: systematic review and meta-analysis.

Journal article

CONTEXT: Selective serotonin reuptake inhibitors (SSRIs) are often described as having a delayed onset of effect in the treatment of depression. However, some trials have reported clinical improvement as early as the first week of treatment. OBJECTIVE: To test the alternative hypotheses of delayed vs early onset of antidepressant action with SSRIs in patients with unipolar depression. DATA SOURCES: Trials identified by searching CENTRAL, The Cochrane Collaboration database of controlled trials (2005), and the reference lists of identified trials and other systematic reviews. STUDY SELECTION: Randomized controlled trials of SSRIs vs placebo for the treatment of unipolar depression in adults that reported outcomes for at least 2 time points in the first 4 weeks of treatment (50 trials from >500 citations identified). Trials were excluded if limited to participants older than 65 years or specific comorbidities. DATA EXTRACTION: Data were extracted on trial design, participant characteristics, and outcomes by a single reviewer. DATA SYNTHESIS: Pooled estimates of treatment effect on depressive symptom rating scales were calculated for weeks 1 through 6 of treatment. In the primary analysis, the pattern of response seen was tested against alternative models of onset of response. The primary analysis incorporated data from 28 randomized controlled trials (n=5872). A model of early treatment response best fit the experimental data. Treatment with SSRIs rather than placebo was associated with clinical improvement by the end of the first week of use. A secondary analysis indicated an increased chance of achieving a 50% reduction in Hamilton Depression Rating Scale scores by 1 week (relative risk, 1.64; 95% confidence interval, 1.2-2.25) with SSRI treatment compared with placebo. CONCLUSIONS: Treatment with SSRIs is associated with symptomatic improvement in depression by the end of the first week of use, and the improvement continues at a decreasing rate for at least 6 weeks.

Authors: Taylor, M; Freemantle, N; Geddes, J; Bhagwagar, Z

• Publication status: Published
• Journal: Archives of general psychiatry
• Volume: 63
• Issue: 11
• Pages: 1217-1223
• Publication date: 2006-11-01
• DOI: 10.1001/archpsyc.63.11.1217
• EISSN: 1538-3636
• ISSN: 0003-990X
• Language: English
• Keywords: Double-Blind Method; Humans; Placebos; Treatment Outcome; Adult; Middle Aged; Randomized Controlled Trials as Topic; Risk; Psychiatric Status Rating Scales; Confidence Intervals; Research Design; Depressive Disorder; Age Factors; Time Factors; Serotonin Uptake Inhibitors