Sertraline effective for acute major depression

Clinical question: 
How effective is sertraline (escitalopram) in the acute phase treatment of major depression?
Bottom line: 
There was evidence favouring sertraline over some other antidepressants for the acute phase treatment of major depression, in terms of efficacy, compared with fluoxetine, (NNT* 10; range, 6 to 14) or acceptability/tolerability, compared with amitriptyline, imipramine, paroxetine and mirtazapine. Follow-up was limited to 24 weeks. However, there were also some differences favouring newer antidepressants in terms of early response (mirtazapine) and acceptability (bupropion). In terms of individual side effects, sertraline was generally associated with a higher rate of participants experiencing diarrhoea. * NNT = number needed to treat to benefit 1 individual
Caveat: 
The overall quality of included studies was low and the reporting of trials was often inadequate. The included studies did not report on all the outcomes that were pre-specified in the protocol of this review. Outcomes of clear relevance to patients and clinicians, in particular, patients’ and their relatives’ attitudes to treatment, and their ability to return to work and resume normal social functioning, were not reported in any of the included studies.
Context: 
Depression is the fourth leading cause of disease burden worldwide and is expected to show a rising trend over the next 20 years. Although both pharmacological and psychological interventions are effective for major depression, antidepressant drugs remain the mainstay of treatment. During the last 20 years, selective serotonin reuptake inhibitors have progressively become the most commonly prescribed antidepressants.
Review CD#: 
CD006117
PEARLS No: 
258
Date: 
April, 2010
Authored by: 
Brian R McAvoy