Paroxetine versus other anti-depressive agents for depression

Abstract

Some possibly clinically meaningful differences between paroxetine and other ADs exist, but no definitive conclusions can be drawn from these findings. In terms of response, there was a moderate quality of evidence that citalopram was better than paroxetine in the acute phase (six to 12 weeks), although only one study contributed data. In terms of early response to treatment (one to four weeks) there was moderate quality of evidence that mirtazapine was better than paroxetine and that paroxetine was better than reboxetine. However there was no clear evidence that paroxetine was better or worse compared with other antidepressants at increasing response to treatment at any time point. Even if some differences were identified, the findings from this review are better thought as hypothesis forming rather than hypothesis testing and it would be reassuring to see the conclusions replicated in future trials. Finally, most of included studies were at unclear or high risk of bias, and were sponsored by the drug industry. The potential for overestimation of treatment effect due to sponsorship bias should be borne in mind.

Effects of paroxetine on spatial memory function and protein kinase C expression in a rat model of depression

“…Paroxetine, a type of highly selective 5-hydroxytryptamine (5-HT)-reuptake inhibitor, can inhibit 5-HT reuptake in synapses and increase the nerve conduction rate of 5-HT, exerting antidepressant effects (9). Due to its rapid action and few adverse side effects, paroxetine has been widely used in the clinical treatment of depression; however, the effects of paroxetine on PKC in depression have not been fully addressed.…”

Outcomes in systematic reviews of complex interventions never reached “high” GRADE ratings when compared with those of simple interventions

“…The picture was quite similar for the reviews of simple interventions: 64% (7/11) explicitly highlighted the adoption of GRADE in the review [53,55,57,59,60,63,65] or included a discussion on the GRADE considerations [53,55,60,65]. Most commonly, the application of GRADE in both the review groups was restricted to the SoF tables, whereas justifications for the evidence ratings were provided in the footnotes below them.…”

“…Meanwhile, 61 outcomes had GRADE ratings for the main comparison [57] X X X X Magni [58] X Mayo-Wilson [59] X X Purgato [60] X Rana [61] X Rothbart [62] X Schoonees [63] X X Taft [64] X X X X Taylor [65] Wang [66] X X Wijkstra [67] Williams [68] in the total of the 11 GRADE-endorsed reviews of simple interventions (see Appendix C at www.jclinepi.com).…”

“…In general, a substantially higher proportion of outcomes were downgraded based on an RoB consideration in the reviews of complex interventions [31e36, 38,40,49,50] as compared with the reviews of simple interventions [57,58,60,63] (76% vs. 34%). Among the most common reasons for downgrading the evidence based on RoB were unclear methods of random sequence generation and allocation concealment [32,33,36,45,58,60,63] in both the review groups.…”

“…Among the most common reasons for downgrading the evidence based on RoB were unclear methods of random sequence generation and allocation concealment [32,33,36,45,58,60,63] in both the review groups. However, in contrast to simple intervention reviews, one of the most commonly stated sources of RoB in the reviews of complex interventions was a lack of participant and personnel blinding [31e36, 38,49].…”