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Review: SSRIs and TCAs equally effective at treating chronic depression and dysthemia; SSRIs are associated with fewer adverse events than TCAs

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Question: What is the efficacy and acceptability of selective serotonin reuptake inhibitors (SSRIs) and tricyclic antidepressants (TCAs) in the treatment of chronic depression?

Outcomes: Primary efficacy outcome: response to treatment, defined as ≥50% decrease on depression scale from baseline to end of treatment. Secondary outcome: remission, defined as an end of treatment severity score on a depression scale below a threshold of clinical significance. Primary acceptability outcome: study withdrawal for any reason. Secondary outcome: any adverse event.


Design: Systematic review and meta-analysis.

Data sources: Cochrane Central Register of Controlled Trials (CENTRAL), MEDLINE, EMBASE, ISI Web of Science, BIOSIS, PsychINFO and CINAHL were searched in January 2010. All volumes of the Archives of General Psychiatry, Journal of Consulting and Clinical Psychiatry and Journal of Affective Disorders and the reference lists of retrieved studies, were hand searched. A cited reference search was conducted in the Social Sciences and Science Citation Index, and the first author of included studies was contacted for information on other published and unpublished studies.

Study selection and analysis: Randomised …

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  • Sources of funding German Ministry of Education and Research.


  • Competing interests None.

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