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Q Is treatment response delayed for selective serotonin reuptake inhibitors in moderate to severe unipolar depression?
Systematic review with meta-analysis.
Cochrane CENTRAL; reference lists of RCTs; reference lists of other systematic reviews. Search date: Cochrane library, issue 1, 2005.
Study selection and analysis:
Randomised controlled trials (RCTs) comparing UK licensed selective serotonin reuptake inhibitors (SSRIs) versus placebo for short-term treatment of moderate to severe unipolar depression, reporting outcomes for at least two time points in the first 4 weeks of treatment were included. Trials solely in adults aged over 65 years or with specific comorbidities were excluded. Standardised effect sizes on depressive symptom rating scales were calculated for each weekly time point for the first 6 weeks. Primary analyses were performed on scales reflecting primary outcomes. Five models of treatment effect were proposed: sudden onset response at week 4; step function response at week 4 and linearly increasing treatment effect; linearly increasing treatment effect; logarithmically increasing treatment effect defined as log (week); or treatment effect defined as …
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