Early Onset of Selective Serotonin Reuptake Inhibitor Antidepressant Action

Abstract

Context: Selective serotonin reuptake inhibitors (SSRIs) are often described as having a delayed onset of effect in the treatment of depression. However, some trials have reported clinical improvement as early as the first week of treatment. Objective: To test the alternative hypotheses of delayed vs early onset of antidepressant action with SSRIs in patients with unipolar depression. Data Sources: Trials identified by searching CENTRAL, The Cochrane Collaboration database of controlled trials (2005), and the reference lists of identified trials and other systematic reviews. Study Selection: Randomized controlled trials of SSRIs vs placebo for the treatment of unipolar depression in adults that reported outcomes for at least 2 time points in the first 4 weeks of treatment (50 trials from >500 citations identified). Trials were excluded if limited to participants older than 65 years or specific comorbidities. Data Extraction: Data were extracted on trial design, participant characteristics, and outcomes by a single reviewer. Data Synthesis: Pooled estimates of treatment effect on depressive symptom rating scales were calculated for weeks 1 through 6 of treatment. In the primary analysis, the pattern of response seen was tested against alternative models of onset of response. The primary analysis incorporated data from 28 randomized controlled trials (n = 5,872). A model of early treatment response best fit the experimental data. Treatment with SSRIs rather than placebo was associated with clinical improvement by the end of the first week of use. A secondary analysis indicated an increased chance of achieving a 50% reduction in Hamilton Depression Rating Scale scores by 1 week (relative risk, 1.64; 95% confidence interval, 1.2-2.25) with SSRI treatment compared with placebo. Conclusions: Treatment with SSRIs is associated with symptomatic improvement in depression by the end of the first week of use, and the improvement continues at a decreasing rate for at least 6 weeks. (PsycINFO Database Record (c) 2016 APA, all rights reserved)

Accession Number: 2006-21397-007. PMID: 17088502 Other Journal Title: A.M.A. Archives of General Psychiatry; JAMA Psychiatry. Partial author list: First Author & Affiliation: Taylor, Matthew J.; Department of Psychiatry, University of Oxford, Warneford Hospital, Oxford, England, matthew.taylor@psych.ox.ac.uk ORCID: 0000-0003-4716-4662. Release Date: 20070226. Correction Date: 20130121. Publication Type: Journal (0100), Peer Reviewed Journal (0110). Format Covered: Print. Document Type: Journal Article. Language: English. Grant Information: Taylor, Matthew J. Major Descriptor: Antidepressant Drugs; Drug Therapy; Major Depression; Serotonin Reuptake Inhibitors; Reuptake. Classification: Clinical Psychopharmacology (3340). Population: Human (10). Location: United Kingdom. Age Group: Adulthood (18 yrs & older) (300); Aged (65 yrs & older) (380). Tests & Measures: Hamilton Rating Scale for Depression DOI: 10.1037/t04100-000; Montgomery-Asberg Depression Rating Scale DOI: 10.1037/t04111-000; Clinical Global Impression Scale. Methodology: Empirical Study; Quantitative Study; Treatment Outcome. References Available: Y. Page Count: 7. Issue Publication Date: Nov, 2006.