Comparative Efficacy and Safety of Selective Serotonin Reuptake Inhibitors and Serotonin‐Norepinephrine Reuptake Inhibitors in Older Adults: A Network Meta‐Analysis

Abstract

There was clear evidence of the effectiveness of sertraline, paroxetine, and duloxetine. There also appears to be a hierarchy of safety associated with the different antidepressants, although there appears to be a dearth of reporting of safety outcomes.

Canadian Network for Mood and Anxiety Treatments (CANMAT) 2016 Clinical Guidelines for the Management of Adults with Major Depressive Disorder

“…128 A recent network meta-analysis, with response as an outcome (>50% reduction in depression score from baseline), demonstrated relative risks compared to placebo of greater than 1.2 for only 3 drugs: sertraline, paroxetine, and duloxetine. 129 A meta-analysis of moderators of treatment response in LLD suggests older adults with longer illness duration and moderate to severe depression benefit from antidepressants compared to placebo, whereas short illness duration does not show antidepressant response. 130 Furthermore, executive dysfunction, especially in the subdomains of planning and organization, has been associated with poor antidepressant treatment response in LLD, which may be a factor in trial heterogeneity.…”

Depression in older adults

“…There remains, however, a paucity of randomised controlled trials of both pharmacological and psychological interventions in the acute treatment of depression. Although studies show treatment efficacy similar to that in younger adults, participants are mainly the “younger old.”7 There is very limited evidence for the effectiveness of treatment for depression in people aged over 75 years, older adults with chronic depression, or for long term treatments to prevent recurrence 8. Despite this, antidepressants are prescribed for longer periods in older people than in younger people,9 while observational data indicate that all classes of antidepressants, including newer drugs, are associated with increased risks of adverse events such as falls and seizures in older people 10.…”

Geriatric characteristics in randomised controlled trials on antidepressant drugs for older adults: a systematic review

“…These mainly focus on co‐variables that are known to be directly related to depression, like severity at baseline or duration of the depressive episode. One meta‐analysis confirms the sparse reporting of potentially relevant adverse events in older adults (Thorlund et al, ).…”