PEARLS 258, April 2010, written by Brian R McAvoy

Clinical question
How effective is sertraline (escitalopram) in the acute phase treatment of major depression?  

Bottom line
There was evidence favouring sertraline over some other antidepressants for the acute phase treatment of major depression, in terms of efficacy, compared with fluoxetine, (NNT* 10; range, 6 to 14) or acceptability/tolerability, compared with amitriptyline, imipramine, paroxetine and mirtazapine. Follow-up was limited to 24 weeks. However, there were also some differences favouring newer antidepressants in terms of early response (mirtazapine) and acceptability (bupropion). In terms of individual side effects, sertraline was generally associated with a higher rate of participants experiencing diarrhoea. * NNT = number needed to treat to benefit 1 individual  

Caveat
The overall quality of included studies was low and the reporting of trials was often inadequate. The included studies did not report on all the outcomes that were pre-specified in the protocol of this review. Outcomes of clear relevance to patients and clinicians, in particular, patients and their relatives attitudes to treatment, and their ability to return to work and resume normal social functioning, were not reported in any of the included studies.

Context
Depression is the fourth leading cause of disease burden worldwide and is expected to show a rising trend over the next 20 years. Although both pharmacological and psychological interventions are effective for major depression, antidepressant drugs remain the mainstay of treatment. During the last 20 years, selective serotonin reuptake inhibitors have progressively become the most commonly prescribed antidepressants.  

Cochrane Systematic Review
Cipriani A et al. Sertraline versus other antidepressive agents for depression. Cochrane Reviews 2009, Issue 2. Article No. CD006117. DOI: 10.1002/14651858CD006117.pub2. This review contains 59 trials involving about 10,000 participants.