Efficacy and adverse reactions of 6 kinds of antidepressants for the treatment of first-episode depression

Abstract

Objective To explore the efficacy and adverse reactions of the 6 kinds of antidepressants for patients with first-episode depression. Methods Three hundred and seven patients, who met the criteria of first-episode major depressive disorder, were randomly assigned into 6 groups and treated by escitalopram ［5-20 mg/d, the mean dosage at 6th weekend was （12.74±4.17）mg/d］, venlafaxine ［75-225 mg/d, the mean dosage at 6th weekend was （114.75±39.81）mg/d］, duloxetine ( with the fixed dosage 60 mg/d), mirtazapine ［7.5-45.0 mg/d, the mean dosage at 6th weekend was （28.94±8.92）mg/d］, reboxetine ［4-12 mg/d, the mean dosage at 6th weekend was （9.39±2.24）mg/d］ and sertraline ［25-200 mg/d, the mean dosage at 6th weekend was （83.65±25.19）mg/d］ respectively for 6 weeks.The Hamilton Depressive Scale (HAMD17) and Montgomery-Asberg depressive Scale (MADRS) were adopted to assess efficacy, and adverse reactions were evaluated with Treatment Emergent Symptom Scale and laboratory tests. Results After the 6-week treatment with escitalopram, venlafaxine, duloxetine, mirtazapine, reboxetine, or sertraline, the remission rates were 56.00%, 64.15%, 50.98%, 48.08%, 40.82% and 46.15% respectively, and response rates were 18.00%, 18.87%, 15.69%, 23.08%, 18.37% and 19.23%, while the drop-out rates were 6.00%, 7.55%, 9.80%, 7.69%, 10.20% and 3.85% respectively. The total remission rates and non-remission rates among the 6 groups were not significantly different (χ2=6.87，P=0.23),and so did between response rate and nonresponse rate（χ2=9.91，P=0.45）.There was no statistical difference among the six treatment groups as for the drop-out rates（χ2=2.08，P=0.84）. There were no significant differences in remission rates and response rates between sertraline group and other 5 groups. But the reducing rates of HAMD and MADRS in escitalopram group were significantly greater than that in sertraline group at the end of the second week (t=2.08, P=0.04; t=2.18, P=0.03). Compared with sertraline group, incidence rates of constipation in venlafaxine group and duloxetine group were significantly greater (P=0.03，P=0.03 respectively). There were significant difference in dizziness and weight gain between mirtazapine group and sertraline group (P=0.03，P=0.01 respectively). Between sertraline group and reboxetine group, there were no significant differences in the incidence rates of adverse reactions. Conclusion The efficacy of the six different kinds of antidepressants prescribed for the first-episode depression is similar. But escitalopram may have a more rapid onset of action and a better efficacy than sertraline in the second week. The total adverse reactions rates of the 6 drugs are similar, but patients are more likely to have constipation with venlafaxeine and duloxetine, and have dizziness and weight gain with mirtazapine than sertraline. Key words: Depressive disorder; Treatment outcome; Adverse drug reaction reporting systems