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Review: Response to SSRIs in unipolar depression occurs in the first week of treatment

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Q Is treatment response delayed for selective serotonin reuptake inhibitors in moderate to severe unipolar depression?


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Systematic review with meta-analysis.

Embedded ImageData sources:

Cochrane CENTRAL; reference lists of RCTs; reference lists of other systematic reviews. Search date: Cochrane library, issue 1, 2005.

Embedded ImageStudy 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 …

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  • For correspondence: Matthew J Taylor, MRCPsych, Department of Psychiatry, University of Oxford, Warneford Hospital, Oxford OX3 7JX, UK; matthew.taylor{at}

  • Sources of funding: Wellcome Trust Research Training Fellowship, National Alliance for Research on Schizophrenia and Depression.


  • Competing interests: Dr Kennedy has received research support, consulting fees or honoraria as a speaker or advisory board member from the following sources: Advanced Neuromodulation Systems Inc, Astra Zeneca, Biovail, Bohehringer Ingelheim, Eli Lilly, GlaxoSmithKline, Janssen-Ortho, Lundbeck, Merck frosst, Organon, Pfizer, Servier and Wyeth.