A meta-analysis of the efficacy and tolerability of paroxetine versus tricyclic antidepressants in the treatment of major depression

This meta-analysis examined efficacy and tolerability data from 39 randomiz ed, double-blind, parallel-group studies comparing paroxetine (n = 1924) wi th clomipramine (n = 141) or other tricyclic antidepressants (TCAs; n = 169 3) in the treatment of major depression. Paroxetine had comparable antidepr essant efficacy to TCAs, including clomipramine, as assessed by response ra tes based on a less than or equal to 50% reduction in Hamilton Rating Scale for Depression (HAMD) total score (58-66%) and a HAMD total score less tha n or equal to 8 (38-48%) at endpoint, and absolute improvements in HAMD tot al score (mean change 12.3-14.5), Absolute improvements in HAMD anxiety fac tor scores were similar between paroxetine and clomipramine (mean change 2. 3 versus 2.4, P = 0.566), but paroxetine was statistically significantly mo re effective on this measure than other TCAs (mean change 2.3 versus 2.1, P = 0.028). The proportion of patients who experienced adverse events with > 1% incidence was statistically significantly lower with paroxetine than wi th clomipramine (64% versus 77%, P = 0.02) or other TCAs (64% versus 71%, P < 0.001). The incidence of patient withdrawals due to adverse events was a lso statistically significantly lower with paroxetine than with clomipramin e (17% versus 27%, P = 0.014), but an advantage seen for paroxetine over ot her TCAs (17% versus 20%, P = 0.130) did not reach statistical significance , These findings demonstrate that paroxetine has comparable efficacy to and better tolerability than TCAs, including clomipramine, and is therefore an appropriate treatment strategy for depression, particularly in the common clinical situation where concomitant anxiety symptoms are present. Int clin Psychopharmacol 16:169-178 (C) 2001 Lippincott Williams & Wilkins.