Selective serotonin reuptake inhibitors in major depression disorder treatment: an umbrella review on systematic reviews

Background Major depressive disorder (MDD) is a common mental problem and one of the leading causes of disability worldwide. SSRIs are the most commonly prescribed types of antidepressants which are called Selective Serotonin Reuptake Inhibitors and used as a primary therapeutic intervention in MDD. This umbrella review aimed to assess the efficacy and tolerability of selected SSRIs. Methods A systematic review on systematic reviews based on meta-analysis was conducted for head-to-head comparisons on 6 antidepressants (fluoxetine, citalopram, escitalopram, sertraline, paroxetine, and fluvoxamine) as monotherapy in the acute-phase treatment for adults with MDD. The primary outcomes included response rate and remission rate. The secondary outcome was the withdrawal rate due to any cause. All articles published on 6 electronic databases, including PubMed, Embase, Scopus, Cochrane, Web of Science, and ProQuest, until 28 August 2018, were searched and analysed. Results Fifteen meta-analysis based systematic reviews finally met all the inclusion criteria and pre-defined outcomes were extracted. Regarding the remission rate and withdrawal rate, statistically, significant comparisons showed that escitalopram was the better choice. Conclusion The descriptive analysis of the included articles showed that generally, escitalopram was more effective than other defined SSRIs in terms of response rate, remission rate, and withdrawal rate.Keypoints This work compiles evidence from multiple meta-analyses based on systematic reviews and provides a clearer picture for assessing the efficacy of SSRIs, clarify current gaps and direction of future research in this category of antidepressants. A minority of included articles attained the high-quality rank according to AMSTAR-2. The descriptive analysis of the included articles showed that generally, escitalopram was more effective than other defined SSRIs in terms of response rate, remission rate, and withdrawal rate.