COMPARATIVE EFFICACY AND SAFETY OF SSRIS VERSUS SNRIS IN THE TREATMENT OF MAJOR DEPRESSIVE DISORDER: A SYSTEMATIC REVIEW

Abstract

Background: Major depressive disorder (MDD) remains a significant global health concern, with selective serotonin reuptake inhibitors (SSRIs) and serotonin-norepinephrine reuptake inhibitors (SNRIs) serving as frontline pharmacotherapies. Despite their widespread use, the relative efficacy and tolerability of these classes continue to be debated .

Objectives: This systematic review aimed to evaluate and compare the therapeutic efficacy, safety, and remission outcomes of SSRIs and SNRIs across diverse populations, including adults, adolescents, and post-stroke patients with MDD.

Methods: Following PRISMA 2020 guidelines, ten randomized controlled trials and meta-analyses were analyzed. Studies included human subjects treated with either SSRIs or SNRIs for MDD, assessing clinical improvement via validated scales such as the HAM-D, MADRS, and CGI-I.

Results: Findings consistently indicated that both SSRIs and SNRIs are effective for MDD, with no substantial difference in overall efficacy. However, SNRIs such as venlafaxine and duloxetine showed marginally superior symptom reduction in severe cases, while SSRIs, particularly escitalopram, demonstrated better tolerability and fewer discontinuations due to adverse effects .

Conclusions: SSRIs remain the preferred first-line treatment due to their favorable safety and tolerability, while SNRIs are suitable for treatment-resistant or severe depressive episodes. The findings reinforce the need for personalized pharmacological strategies guided by symptom profile, comorbidities, and tolerability.