SSRIs significantly increase the risk of both serious and non-serious adverse events .
The potential small beneficial effects seem to be outweighed by harmful effects .
Background The evidence on selective serotonin reuptake inhibitors ( SSRIs ) for major depressive disorder is unclear .
Methods Our objective was to conduct a systematic review assessing the effects of SSRIs versus placebo , ‘ active ’ placebo , or no intervention in adult participants with major depressive disorder .
A Double-blind, Randomized Trial of St John's Wort, Fluoxetine, and Placebo in Major Depressive Disorder
Objective : This study looks to compare the antidepressant efficacy and safety of a st and ardized extract of St John 's wort with both placebo and fluoxetine . Method : After a 1-week single-blind washout , patients with major depressive disorder diagnosed by Structured Clinical Interview for Diagnostic and Statistical Manual of Mental Disorders , Fourth Edition were r and omized to 12 weeks of double-blind treatment with LI-160 St John 's wort extract ( 900 mg/d ) , fluoxetine ( 20 mg/d ) , or placebo . The 17-item Hamilton Rating Scale for Depression ( HAMD-17 ) was the primary efficacy measure , and analysis of covariance was used to compare differences in end point HAMD-17 scores across the 3 treatment groups , treating the baseline HAMD-17 as the covariate . Results : One hundred thirty-five patients ( 57 % women ; mean age , 37.3 ± 11.0 ; mean HAMD-17 , 19.7 ± 3.2 ) were r and omized to double-blind treatment and were included in the intent-to-treat analyses . Analysis of covariance analyses showed lower mean HAMD-17 scores at end point in the St John 's wort group ( n = 45 ; mean ± SD , 10.2 ± 6.6 ) compared with the fluoxetine group ( n = 47 ; 13.3 ± 7.3 ; P < 0.03 ) and a trend toward a similar finding relative to the placebo group ( n = 43 ; 12.6 ± 6.4 ; P = 0.096 ) . There was also a trend toward higher rates of remission ( HAMD-17 < 8) in the St John 's wort group ( 38 % ) compared with the fluoxetine group ( 30 % ) and the placebo group ( 21 % ) . Overall , St John 's wort appeared to be safe and well tolerated . Conclusion : St John 's wort was significantly more effective than fluoxetine and showed a trend toward superiority over placebo . A ( 25 % ) smaller than planned sample size is likely to account for the lack of statistical significance for the advantage ( indicating a moderate effect size , d = 0.45 ) of St John 's wort over placebo
SSRIs significantly increase the risk of both serious and non-serious adverse events .
The potential small beneficial effects seem to be outweighed by harmful effects .
Background The evidence on selective serotonin reuptake inhibitors ( SSRIs ) for major depressive disorder is unclear .
Methods Our objective was to conduct a systematic review assessing the effects of SSRIs versus placebo , ‘ active ’ placebo , or no intervention in adult participants with major depressive disorder .