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Is One Selective Serotonin Reuptake Inhibitor Better Than Another?

Is One Selective Serotonin Reuptake Inhibitor Better Than Another? To the Editor: We question the main conclusion of Dr Kroenke and colleagues1 that paroxetine, fluoxetine, and sertraline had similar efficacy for the treatment of depressive symptoms and improvement in health-related quality of life. Although there were no statistically significant differences when the measures were analyzed individually, we noticed a pattern in the outcomes that did not appear to be random. If there were indeed no differences among outcomes for the 3 medications, then the relative pattern of outcomes should have been distributed randomly across measures; that is, each medication should have produced highest or best scores about as often as each other medication. We tested the hypothesis of random distribution of outcomes by ranking the medications in order of the degree of improvement (at 3- and 9-month follow-up) on each of the outcome measures. A combined analysis of all outcomes (their Tables 2 through 5) is shown in Table 1. It is apparent that sertraline is ranked first more often than either paroxetine or fluoxetine, which appear equally likely to be ranked second. Simple inspection suggests that the pattern is not random, a suspicion confirmed by a χ2 analysis through which the random distribution hypothesis was rejected (P<.001). View LargeDownload Table. Rankings for All Measures To determine whether baseline measures might have influenced the nonrandom distribution (ie, whether one group might have been sicker or healthier than the others), we ranked baseline psychological and functional measures. The random distribution hypothesis was not rejected (P = .85 for psychological measures, P = .54 for functional measures, and P = .81 for combined rankings of psychological and functional measures). The baseline measures were distributed randomly among the 3 groups. Thus, we are led to believe that the data support a superior overall outcome for sertraline over both fluoxetine and paroxetine. We wonder whether analyzing the data with multivariate analysis of variance, so that all measures may be considered simultaneously, might reveal differences between the medications that cannot be detected with separate, univariate analyses. We also wonder whether the authors have considered possible explanations for a nonrandom pattern of outcomes. References 1. Kroenke KWest SLSwindle R et al. Similar effectiveness of paroxetine, fluoxetine, and sertraline in primary care: a randomized trial. JAMA. 2001;286:2947-2955.Google Scholar http://www.deepdyve.com/assets/images/DeepDyve-Logo-lg.png JAMA American Medical Association

Is One Selective Serotonin Reuptake Inhibitor Better Than Another?

Elliott, Richard L.; Dane, Francis C.
JAMA , Volume 287 (15) – Apr 17, 2002
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References (2)

Publisher
American Medical Association
Copyright
Copyright © 2002 American Medical Association. All Rights Reserved.
ISSN
0098-7484
eISSN
1538-3598
DOI
10.1001/jama.287.15.1935
Publisher site
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Abstract

To the Editor: We question the main conclusion of Dr Kroenke and colleagues1 that paroxetine, fluoxetine, and sertraline had similar efficacy for the treatment of depressive symptoms and improvement in health-related quality of life. Although there were no statistically significant differences when the measures were analyzed individually, we noticed a pattern in the outcomes that did not appear to be random. If there were indeed no differences among outcomes for the 3 medications, then the relative pattern of outcomes should have been distributed randomly across measures; that is, each medication should have produced highest or best scores about as often as each other medication. We tested the hypothesis of random distribution of outcomes by ranking the medications in order of the degree of improvement (at 3- and 9-month follow-up) on each of the outcome measures. A combined analysis of all outcomes (their Tables 2 through 5) is shown in Table 1. It is apparent that sertraline is ranked first more often than either paroxetine or fluoxetine, which appear equally likely to be ranked second. Simple inspection suggests that the pattern is not random, a suspicion confirmed by a χ2 analysis through which the random distribution hypothesis was rejected (P<.001). View LargeDownload Table. Rankings for All Measures To determine whether baseline measures might have influenced the nonrandom distribution (ie, whether one group might have been sicker or healthier than the others), we ranked baseline psychological and functional measures. The random distribution hypothesis was not rejected (P = .85 for psychological measures, P = .54 for functional measures, and P = .81 for combined rankings of psychological and functional measures). The baseline measures were distributed randomly among the 3 groups. Thus, we are led to believe that the data support a superior overall outcome for sertraline over both fluoxetine and paroxetine. We wonder whether analyzing the data with multivariate analysis of variance, so that all measures may be considered simultaneously, might reveal differences between the medications that cannot be detected with separate, univariate analyses. We also wonder whether the authors have considered possible explanations for a nonrandom pattern of outcomes. References 1. Kroenke KWest SLSwindle R et al. Similar effectiveness of paroxetine, fluoxetine, and sertraline in primary care: a randomized trial. JAMA. 2001;286:2947-2955.Google Scholar

Journal

JAMA – American Medical Association

Published: Apr 17, 2002

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