Regular Research ArticlesEfficacy of Second Generation Antidepressants in Late-Life Depression: A Meta-Analysis of the Evidence
Section snippets
METHODS
The Cochrane Controlled Trials Register (2006, Issue 3) was searched using terms previously employed by the Cochrane group in a similar search (elder, geriatr, senil, older, old age, late-life, aged, 80-and-over, and depress).6 These terms were supplemented with the terms antidepressants, fluoxetine, sertraline, paroxetine, citalopram, escitalopram, venlafaxine, duloxetine, mirtazapine, bupropion, nefazodone, and trazodone (second-generation antidepressants marketed in the United States).
Search Flow (Results)
The search strategy yielded 192 Cochrane Controlled Trials Register citations and 136 citations from MEDLINE (Fig. 1). The Cochrane search identified 11 placebo-controlled studies and the MEDLINE search 25 placebo-controlled studies. Of these, five trials from the Cochrane search and six trials from the MEDLINE search met inclusion criteria. (The MEDLINE search included all of the Cochrane trials plus one recently published report). A search of abstracts, posters, and slide presentations from
DISCUSSION
Second-generation antidepressants are more effective than placebo during acute treatment of adults 60 years and older with Major Depression in terms of response and remission defined by depression rating scale scores, but the magnitude of this effect is small and variable. The numbers needed to treat calculated from the RDs by meta-analysis were 13 for response and 20 for remission, implying that for every 100 patients treated 8 would show a response and 5 a remission in excess of placebo
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Dr. Nelson conducted the initial search. Drs. Nelson and Schneider performed the trial selection and data checking. All authors participated in analysis of the data and preparation of the manuscript.
The authors received no financial support for this meta-analysis.
This meta-analysis was presented at the Annual Meeting of the AAGP, New Orleans, March 1–4, 2007.