Cochrane · systematic review · CD006531

Paroxetine versus other anti‐depressive agents for depression

Purgato, M, Papola, D, Gastaldon, C, et al. · Cochrane Database of Systematic Reviews · 2014 · Cochrane Library

Common Mental DisordersAMSTAR 2: not assessed
SoF tableOnly the outcomes this review put in its Summary of Findings table are listed (the Cochrane Handbook caps them at about seven per comparison). Its other analyses are not shown here.
Questions
133
current version
GRADE rated
93
No studies
1
Included studies
NR
No studies 1 · 0.8%Ungraded 39 · 29.3%Very low 0 · 0%Low 5 · 3.8%Moderate 86 · 64.7%High 2 · 1.5%

Ungraded means an effect was reported without a GRADE rating; it is not a gap. No studies means the review found nothing to answer the question. The six categories are a display order, not a score.

Questions and results

Paroxetine compared with older ADs for depression

Population: patients with depression
7 questions
OutcomeEffectEvidenceStatus / GRADE
Failure to respond at endpoint (6‐12 weeks)
Paroxetine vs older ADs
OR 1.04 [0.92, 1.17]34 studies · 4647 participantsModerate
Downgraded: risk of bias
Failure to respond at 1‐4 weeks
Paroxetine vs older ADs
OR 0.9 [0.61, 1.33]4 studies · 526 participantsLow
Downgraded: risk of bias
Failure to respond at 16‐24 weeks
Paroxetine vs older ADs
no estimate extracted0 studies · 0 participantsUngraded
Failure to remit at endpoint
Paroxetine vs older ADs
OR 1.23 [0.49, 3.07]3 studies · 401 participantsLow
Downgraded: risk of bias, inconsistency
SMD at endpoint
Paroxetine vs older ADs
no estimate extracted35 studies · 4745 participantsModerate
Downgraded: risk of bias
Failure to complete ‐ any cause ‐
Paroxetine vs older ADs
OR 0.84 [0.73, 0.96]44 studies · 6810 participantsModerate
Downgraded: risk of bias
Participants with at least some Side Effects
Paroxetine vs older ADs
OR 0.64 [0.54, 0.77]42 studies · 6132 participantsModerate
Downgraded: risk of bias

Paroxetine compared with agomelatine for depression

Population: patients with depression
7 questions
OutcomeEffectEvidenceStatus / GRADE
Failure to respond at endpoint (6‐12 weeks)
Paroxetine vs agomelatine
OR 1.25 [0.78, 2.01]1 study · 284 participantsModerate
Downgraded: risk of bias
Failure to respond at 1‐4 weeks
Paroxetine vs agomelatine
no estimate extracted0 studies · 0 participantsUngraded
Failure to respond at 16‐24 weeks
Paroxetine vs agomelatine
no estimate extracted0 studies · 0 participantsUngraded
Failure to remit at endpoint HDRS
Paroxetine vs agomelatine
OR 1.27 [0.75, 2.14]1 study · 284 participantsModerate
Downgraded: risk of bias
SMD at endpoint HDRS
Paroxetine vs agomelatine
no estimate extracted4 studies · 1074 participantsModerate
Downgraded: risk of bias
Failure to complete ‐ any cause ‐
Paroxetine vs agomelatine
OR 0.99 [0.57, 1.71]1 study · 284 participantsModerate
Downgraded: risk of bias
Participants with at least some Side Effects
Paroxetine vs agomelatine
OR 1.6 [0.99, 2.59]1 study · 284 participantsModerate
Downgraded: risk of bias

Paroxetine compared with amisulpride for depression

Population: patients with depression
7 questions
OutcomeEffectEvidenceStatus / GRADE
Failure to respond at endpoint (6‐12 weeks)
Paroxetine vs amisulpride
OR 0.65 [0.36, 1.15]1 study · 277 participantsModerate
Downgraded: risk of bias
Failure to respond at 1‐4 weeks
Paroxetine vs amisulpride
no estimate extracted0 studies · 0 participantsUngraded
Failure to respond at 16‐24 weeks
Paroxetine vs amisulpride
no estimate extracted0 studies · 0 participantsUngraded
Failure to remit at endpoint
Paroxetine vs amisulpride
OR 0.85 [0.49, 1.46]1 study · 277 participantsModerate
Downgraded: risk of bias
SMD at endpoint
Paroxetine vs amisulpride
no estimate extracted1 study · 272 participantsModerate
Downgraded: risk of bias
Failure to complete ‐ any cause ‐
Paroxetine vs amisulpride
no estimate extracted0 studies · 0 participantsUngraded
Participants with at least some Side Effects
Paroxetine vs amisulpride
OR 1.49 [0.89, 2.5]1 study · 277 participantsModerate
Downgraded: risk of bias

Paroxetine compared with aprepitant for depression

Population: patients with depression
7 questions
OutcomeEffectEvidenceStatus / GRADE
Failure to respond at endpoint (6‐12 weeks)
Paroxetine vs aprepitant
no estimate extracted0 studies · 0 participantsUngraded
Failure to respond at 1‐4 weeks
Paroxetine vs aprepitant
no estimate extracted0 studies · 0 participantsUngraded
Failure to respond at 16‐24 weeks
Paroxetine vs aprepitant
no estimate extracted0 studies · 0 participantsUngraded
Failure to remit at endpoint
Paroxetine vs aprepitant
OR 1.57 [1.08, 2.29]4 studies · 807 participantsHigh
SMD at endpoint
Paroxetine vs aprepitant
no estimate extracted1 study · 102 participantsHigh
Failure to complete ‐ any cause ‐
Paroxetine vs aprepitant
OR 1.53 [0.76, 3.09]1 study · 143 participantsModerate
Downgraded: risk of bias
Participants with at least some Side Effects
Paroxetine vs aprepitant
no estimate extracted0 studies · 0 participantsUngraded

Paroxetine compared with bupropion for depression

Population: patients with depression
7 questions
OutcomeEffectEvidenceStatus / GRADE
Failure to respond at endpoint (6‐12 weeks)
Paroxetine vs bupropion
OR 0.73 [0.3, 1.79]1 study · 100 participantsModerate
Downgraded: risk of bias
Failure to respond at 1‐4 weeks
Paroxetine vs bupropion
no estimate extracted0 studies · 0 participantsUngraded
Failure to respond at 16‐24 weeks
Paroxetine vs bupropion
no estimate extracted0 studies · 0 participantsUngraded
Failure to remit at endpoint
Paroxetine vs bupropion
no estimate extracted0 studies · 0 participantsUngraded
SMD at endpoint
Paroxetine vs bupropion
no estimate extracted1 study · 132 participantsModerate
Downgraded: risk of bias
Failure to complete ‐ any cause ‐
Paroxetine vs bupropion
OR 1.16 [0.62, 2.2]2 studies · 240 participantsModerate
Downgraded: risk of bias
Participants with at least some Side Effects
Paroxetine vs bupropion
OR 1.6 [0.43, 5.92]1 study · 140 participantsModerate
Downgraded: risk of bias

Paroxetine compared with citalopram for depression

Population: patients with depression
7 questions
OutcomeEffectEvidenceStatus / GRADE
Failure to respond at endpoint (6‐12 weeks)
Paroxetine vs citalopram
OR 1.54 [1.04, 2.28]1 study · 406 participantsModerate
Downgraded: risk of bias
Failure to respond at 1‐4 weeks
Paroxetine vs citalopram
no estimate extracted0 studies · 0 participantsUngraded
Failure to respond at 16‐24 weeks
Paroxetine vs citalopram
no estimate extracted0 studies · 0 participantsUngraded
Failure to remit at endpoint
Paroxetine vs citalopram
no estimate extractedNRNo studies
SMD at endpoint
Paroxetine vs citalopram
no estimate extracted1 study · 201 participantsModerate
Downgraded: risk of bias
Failure to complete ‐ any cause ‐
Paroxetine vs citalopram
OR 0.99 [0.61, 1.6]1 study · 406 participantsModerate
Downgraded: risk of bias
Participants with at least some Side Effects
Paroxetine vs citalopram
OR 0.74 [0.46, 1.21]1 study · 406 participantsModerate
Downgraded: risk of bias

Paroxetine compared with duloxetine for depression

Population: patients with depression
7 questions
OutcomeEffectEvidenceStatus / GRADE
Failure to respond at endpoint (6‐12 weeks)
Paroxetine vs duloxetine
OR 0.89 [0.7, 1.14]6 studies · 1821 participantsModerate
Downgraded: risk of bias
Failure to respond at 1‐4 weeks
Paroxetine vs duloxetine
no estimate extracted0 studies · 0 participantsUngraded
Failure to respond at 16‐24 weeks
Paroxetine vs duloxetine
no estimate extracted0 studies · 0 participantsUngraded
Failure to remit at endpoint
Paroxetine vs duloxetine
OR 0.98 [0.8, 1.19]6 studies · 1821 participantsModerate
Downgraded: risk of bias
SMD at endpoint
Paroxetine vs duloxetine
no estimate extracted6 studies · 1481 participantsModerate
Downgraded: risk of bias
Failure to complete ‐ any cause ‐
Paroxetine vs duloxetine
OR 0.97 [0.77, 1.23]6 studies · 1821 participantsModerate
Downgraded: risk of bias
Participants with at least some Side Effects
Paroxetine vs duloxetine
OR 0.81 [0.64, 1.01]6 studies · 1870 participantsModerate
Downgraded: risk of bias

Paroxetine compared with escitalopram for depression

Population: depression
7 questions
OutcomeEffectEvidenceStatus / GRADE
Failure to respond at endpoint (6‐12 weeks)
Paroxetine vs escitalopram
OR 1.12 [0.76, 1.65]2 studies · 784 participantsModerate
Downgraded: risk of bias
Failure to respond at 1‐4 weeks
Paroxetine vs escitalopram
no estimate extracted0 studies · 0 participantsUngraded
Failure to respond at 16‐24 weeks
Paroxetine vs escitalopram
OR 1.36 [0.87, 2.12]1 study · 459 participantsModerate
Downgraded: risk of bias
Failure to remit at endpoint
Paroxetine vs escitalopram
OR 1.15 [0.6, 2.22]2 studies · 784 participantsLow
Downgraded: risk of bias, inconsistency
SMD at endpoint
Paroxetine vs escitalopram
no estimate extracted2 studies · 772 participantsLow
Downgraded: risk of bias, inconsistency
Failure to complete ‐ any cause ‐
Paroxetine vs escitalopram
OR 1.47 [0.77, 2.79]2 studies · 784 participantsModerate
Downgraded: risk of bias
Participants with at least some Side Effects
Paroxetine vs escitalopram
OR 1.28 [0.86, 1.91]1 study · 454 participantsModerate
Downgraded: risk of bias

Paroxetine compared with fluoxetine for depression

Population: patients with depression
7 questions
OutcomeEffectEvidenceStatus / GRADE
Failure to respond at endpoint (6‐12 weeks)
Paroxetine vs fluoxetine
OR 1.98 [0.79, 1.23]11 studies · 2418 participantsModerate
Downgraded: risk of bias
Failure to respond at 1‐4 weeks
Paroxetine vs fluoxetine
no estimate extracted0 studies · 0 participantsUngraded
Failure to respond at 16‐24 weeks
Paroxetine vs fluoxetine
no estimate extracted0 studies · 0 participantsUngraded
Failure to remit at endpoint
Paroxetine vs fluoxetine
no estimate extracted0 studies · 0 participantsUngraded
SMD at endpoint
Paroxetine vs fluoxetine
no estimate extracted9 studies · 2109 participantsModerate
Downgraded: risk of bias
Failure to complete ‐ any cause ‐ total drop out rate
Paroxetine vs fluoxetine
OR 1.05 [0.89, 1.23]13 studies · 2798 participantsModerate
Downgraded: risk of bias
Participants with at least some Side Effects
Paroxetine vs fluoxetine
OR 0.94 [0.69, 1.28]9 studies · 2255 participantsModerate
Downgraded: risk of bias

Paroxetine compared with fluvoxamine for depression

Population: patients with depression
7 questions
OutcomeEffectEvidenceStatus / GRADE
Failure to respond at endpoint (6‐12 weeks)
Paroxetine vs fluvoxamine
OR 1.19 [0.72, 1.94]3 studies · 261 participantsModerate
Downgraded: risk of bias
Failure to respond at 1‐4 weeks
Paroxetine vs fluvoxamine
OR 0.71 [0.41, 1.24]3 studies · 281 participantsModerate
Downgraded: risk of bias
Failure to respond at 16‐24 weeks
Paroxetine vs fluvoxamine
no estimate extracted0 studies · 0 participantsUngraded
Failure to remit at endpoint
Paroxetine vs fluvoxamine
OR 0.78 [0.44, 1.38]3 studies · 261 participantsModerate
Downgraded: risk of bias
SMD at endpoint
Paroxetine vs fluvoxamine
no estimate extracted1 study · 58 participantsModerate
Downgraded: risk of bias
Failure to complete ‐ any cause ‐
Paroxetine vs fluvoxamine
OR 0.96 [0.54, 1.72]3 studies · 261 participantsModerate
Downgraded: risk of bias
Participants with at least some Side Effects
Paroxetine vs fluvoxamine
OR 1.12 [0.42, 2.97]3 studies · 261 participantsModerate
Downgraded: risk of bias

Paroxetine compared with hypericum for depression

Population: patients with depression
7 questions
OutcomeEffectEvidenceStatus / GRADE
Failure to respond at endpoint (6‐12 weeks)
Paroxetine vs hypericum
OR 1.6 [0.95, 2.69]1 study · 251 participantsModerate
Downgraded: risk of bias
Failure to respond at 1‐4 weeks
Paroxetine vs hypericum
no estimate extracted0 studies · 0 participantsUngraded
Failure to respond at 16‐24 weeks
Paroxetine vs hypericum
no estimate extracted0 studies · 0 participantsUngraded
Failure to remit at endpoint
Paroxetine vs hypericum
OR 1.84 [1.11, 3.06]1 study · 251 participantsModerate
Downgraded: risk of bias
SMD at endpoint
Paroxetine vs hypericum
no estimate extracted1 study · 244 participantsModerate
Downgraded: risk of bias
Failure to complete ‐ any cause ‐
Paroxetine vs hypericum
OR 1.9 [0.98, 3.67]1 study · 251 participantsModerate
Downgraded: risk of bias
Participants with at least some Side Effects
Paroxetine vs hypericum
OR 2.6 [1.51, 4.46]1 study · 251 participantsModerate
Downgraded: risk of bias

Paroxetine compared with milnacipran for depression

Population: patients with depression
7 questions
OutcomeEffectEvidenceStatus / GRADE
Failure to respond at endpoint (6‐12 weeks)
Paroxetine vs milnacipran
OR 0.93 [0.59, 1.47]1 study · 302 participantsModerate
Downgraded: risk of bias
Failure to respond at 1‐4 weeks
Paroxetine vs milnacipran
no estimate extracted0 studies · 0 participantsUngraded
Failure to respond at 16‐24 weeks
Paroxetine vs milnacipran
no estimate extracted0 studies · 0 participantsUngraded
Failure to remit at endpoint
Paroxetine vs milnacipran
OR 0.92 [0.57, 1.49]1 study · 302 participantsModerate
Downgraded: risk of bias
SMD at endpoint
Paroxetine vs milnacipran
no estimate extracted1 study · 299 participantsModerate
Downgraded: risk of bias
Failure to complete ‐ any cause ‐
Paroxetine vs milnacipran
OR 1.17 [0.67, 2.3]2 studies · 343 participantsModerate
Downgraded: risk of bias
Participants with at least some Side Effects
Paroxetine vs milnacipran
OR 0.69 [0.41, 1.15]1 study · 302 participantsModerate
Downgraded: risk of bias

Paroxetine compared with mirtazapine for depression

Population: patients with depression
7 questions
OutcomeEffectEvidenceStatus / GRADE
Failure to respond at endpoint (6‐12 weeks)
Paroxetine vs mirtazapine
OR 1.2 [0.9, 1.61]4 studies · 766 participantsModerate
Downgraded: risk of bias
Failure to respond at 1‐4 weeks
Paroxetine vs mirtazapine
OR 2.39 [1.42, 4.02]3 studies · 726 participantsModerate
Downgraded: risk of bias
Failure to respond at 16‐24 weeks
Paroxetine vs mirtazapine
OR 1.41 [0.81, 2.48]3 studies · 726 participantsModerate
Downgraded: risk of bias
Failure to remit at endpoint
Paroxetine vs mirtazapine
OR 1.52 [1.13, 2.06]4 studies · 766 participantsModerate
Downgraded: risk of bias
SMD at endpoint
Paroxetine vs mirtazapine
no estimate extracted1 study · 246 participantsModerate
Downgraded: risk of bias
Failure to complete ‐ any cause ‐
Paroxetine vs mirtazapine
OR 1.26 [0.91, 1.74]3 studies · 726 participantsModerate
Downgraded: risk of bias
Participants with at least some Side Effects
Paroxetine vs mirtazapine
OR 1.07 [0.76, 1.5]3 studies · 726 participantsModerate
Downgraded: risk of bias

Paroxetine compared with nefazodone for depression

Population: patients with depression
7 questions
OutcomeEffectEvidenceStatus / GRADE
Failure to respond at endpoint (6‐12 weeks)
Paroxetine vs nefazodone
OR 0.31 [0.07, 1.25]1 study · 40 participantsModerate
Downgraded: risk of bias
Failure to respond at 1‐4 weeks
Paroxetine vs nefazodone
no estimate extracted0 studies · 0 participantsUngraded
Failure to respond at 16‐24 weeks
Paroxetine vs nefazodone
OR 0.64 [0.17, 2.38]1 study · 40 participantsModerate
Downgraded: risk of bias
Failure to remit at endpoint
Paroxetine vs nefazodone
no estimate extracted0 studies · 0 participantsUngraded
SMD at endpoint
Paroxetine vs nefazodone
no estimate extracted2 studies · 235 participantsModerate
Downgraded: risk of bias
Failure to complete ‐ any cause ‐
Paroxetine vs nefazodone
OR 0.53 [0.11, 2.6]1 study · 40 participantsModerate
Downgraded: risk of bias
Participants with at least some Side Effects
Paroxetine vs nefazodone
OR 0.69 [0.34, 1.4]1 study · 206 participantsModerate
Downgraded: risk of bias

Paroxetine compared with reboxetine for depression

Population: patients with depression
7 questions
OutcomeEffectEvidenceStatus / GRADE
Failure to respond at endpoint (6‐12 weeks)
Paroxetine vs reboxetine
OR 0.82 [0.66, 1.02]3 studies · 1369 participantsModerate
Downgraded: risk of bias
Failure to respond at 1‐4 weeks
Paroxetine vs reboxetine
OR 0.66 [0.5, 0.87]3 studies · 1375 participantsModerate
Downgraded: risk of bias
Failure to respond at 16‐24 weeks
Paroxetine vs reboxetine
no estimate extracted0 studies · 0 participantsUngraded
Failure to remit at endpoint
Paroxetine vs reboxetine
no estimate extracted0 studies · 0 participantsUngraded
SMD at endpoint
Paroxetine vs reboxetine
no estimate extracted3 studies · 1291 participantsModerate
Downgraded: risk of bias
Failure to complete ‐ any cause ‐
Paroxetine vs reboxetine
OR 0.78 [0.51, 1.19]3 studies · 1375 participantsModerate
Downgraded: risk of bias
Participants with at least some Side Effects
Paroxetine vs reboxetine
OR 1.08 [0.74, 1.58]3 studies · 1375 participantsModerate
Downgraded: risk of bias

Paroxetine compared with sertraline for depression

Population: patients with depression
7 questions
OutcomeEffectEvidenceStatus / GRADE
Failure to respond at endpoint (6‐12 weeks)
Paroxetine vs sertraline
OR 1.25 [0.89, 1.77]3 studies · 618 participantsModerate
Downgraded: risk of bias
Failure to respond at 1‐4 weeks
Paroxetine vs sertraline
no estimate extracted0 studies · 0 participantsUngraded
Failure to respond at 16‐24 weeks
Paroxetine vs sertraline
no estimate extracted0 studies · 0 participantsUngraded
Failure to remit at endpoint
Paroxetine vs sertraline
OR 0.94 [0.67, 1.34]2 studies · 545 participantsModerate
Downgraded: risk of bias
SMD at endpoint
Paroxetine vs sertraline
no estimate extracted1 study · 353 participantsModerate
Downgraded: risk of bias
Failure to complete ‐ any cause ‐
Paroxetine vs sertraline
OR 1.37 [0.52, 3.6]2 studies · 426 participantsModerate
Downgraded: risk of bias
Participants with at least some Side Effects
Paroxetine vs sertraline
no estimate extracted0 studies · 0 participantsUngraded

Paroxetine compared with tianeptine for depression

Population: patients with depression
7 questions
OutcomeEffectEvidenceStatus / GRADE
Failure to respond at endpoint (6‐12 weeks)
Paroxetine vs tianeptine
OR 1.04 [0.71, 1.53]3 studies · 648 participantsModerate
Downgraded: risk of bias
Failure to respond at 1‐4 weeks
Paroxetine vs tianeptine
no estimate extracted0 studies · 0 participantsUngraded
Failure to respond at 16‐24 weeks
Paroxetine vs tianeptine
no estimate extracted0 studies · 0 participantsUngraded
Failure to remit at endpoint
Paroxetine vs tianeptine
OR 0.66 [0.18, 2.36]1 study · 44 participantsModerate
Downgraded: risk of bias
SMD at endpoint
Paroxetine vs tianeptine
no estimate extracted3 studies · 586 participantsModerate
Downgraded: risk of bias
Failure to complete ‐ any cause ‐
Paroxetine vs tianeptine
OR 1.46 [0.75, 2.85]3 studies · 648 participantsModerate
Downgraded: risk of bias
Participants with at least some Side Effects
Paroxetine vs tianeptine
OR 1.26 [0.89, 1.78]2 studies · 604 participantsModerate
Downgraded: risk of bias

Paroxetine compared with trazodone for depression

Population: patients with depression
7 questions
OutcomeEffectEvidenceStatus / GRADE
Failure to respond at endpoint (6‐12 weeks)
Paroxetine vs trazodone
OR 0.71 [0.21, 2.41]1 study · 108 participantsModerate
Downgraded: risk of bias
Failure to respond at 1‐4 weeks
Paroxetine vs trazodone
OR 0.54 [0.25, 1.19]1 study · 108 participantsModerate
Downgraded: risk of bias
Failure to respond at 16‐24 weeks
Paroxetine vs trazodone
no estimate extracted0 studies · 0 participantsUngraded
Failure to remit at endpoint
Paroxetine vs trazodone
OR 1.06 [0.47, 2.38]1 study · 108 participantsModerate
Downgraded: risk of bias
SMD at endpoint
Paroxetine vs trazodone
no estimate extracted1 study · 108 participantsModerate
Downgraded: risk of bias
Failure to complete ‐ any cause ‐
Paroxetine vs trazodone
no estimate extracted0 studies · 0 participantsUngraded
Participants with at least some Side Effects
Paroxetine vs trazodone
OR 0.68 [0.3, 1.55]1 study · 108 participantsModerate
Downgraded: risk of bias

Paroxetine compared with venlafaxine for depression

Population: patients with depression
7 questions
OutcomeEffectEvidenceStatus / GRADE
Failure to respond at endpoint (6‐12 weeks)
Paroxetine vs venlafaxine
OR 1.1 [0.58, 2.11]4 studies · 747 participantsLow
Downgraded: risk of bias, inconsistency
Failure to respond at 1‐4 weeks
Paroxetine vs venlafaxine
no estimate extracted0 studies · 0 participantsUngraded
Failure to respond at 16‐24 weeks
Paroxetine vs venlafaxine
no estimate extracted0 studies · 0 participantsUngraded
Failure to remit at endpoint
Paroxetine vs venlafaxine
OR 1.57 [1.08, 2.29]4 studies · 807 participantsModerate
Downgraded: risk of bias
SMD at endpoint
Paroxetine vs venlafaxine
no estimate extracted2 studies · 411 participantsModerate
Downgraded: risk of bias
Failure to complete ‐ any cause ‐
Paroxetine vs venlafaxine
OR 1.08 [0.82, 1.44]6 studies · 1079 participantsModerate
Downgraded: risk of bias
Participants with at least some Side Effects
Paroxetine vs venlafaxine
OR 1.01 [0.52, 1.95]2 studies · 200 participantsModerate
Downgraded: risk of bias