Comparative effectiveness of second-generation antidepressants for accompanying anxiety, insomnia, and pain in depressed patients: a systematic review
Depression and Anxiety, 05/04/2012  Evidence Based Medicine  Clinical Article

Thaler KJ et al. – Evidence guiding the selection of an second–generation antidepressant based on accompanying symptoms of depression is limited. Very few trials were designed and adequately powered to answer questions about accompanying symptoms; analyses were generally of subgroups in larger major depressive disorder trials.

• The authors conducted searches in multiple databases including MEDLINE, Embase, the Cochrane Library, International Pharmaceutical Abstracts, and PsycINFO, from 1980 through August 2011 and reviewed reference lists of pertinent articles.
• They dually reviewed abstracts, full-text articles, and abstracted data.
• They included randomized, head-to-head trials of SGAs of at least 6 weeks’ duration.
• They grouped SGAs into three classes for the analysis: selective serotonin reuptake inhibitors (SSRIs), serotonin norepinephrine reuptake inhibitors, and others.
• They graded the strength of the evidence as high, moderate, low, or very low based on the Grading of Recommendations Assessment, Development and Evaluation (GRADE) Working Group (GRADE) approach.

• The authors located 19 head-to-head trials in total: 11 on anxiety, six on insomnia, and four on pain.
• For the majority of comparisons, the strength of the evidence was moderate or low: evidence is weakened by inconsistency and imprecision.
• For treating anxiety, insomnia, and pain moderate evidence suggests that the SSRIs do not differ.