• Paolo Girardi, Maurizio Pompili, Marco Innamorati, Michele Mancini, Gianluca Serafini, Lorenzo Mazzarini, Antonio Del Casale, Roberto Tatarelli, and Ross J Baldessarini.
• Department of Psychiatry, Sant'Andrea Hospital, Sapienza University of Rome, Rome, Italy.
• Hum Psychopharmacol. 2009 Apr 1;24(3):177-90.

BackgroundRandomized controlled trials (RCTs) of duloxetine (DLX), an inhibitor of both norepinephrine and serotonin transporters (SNRI), have tested its efficacy in acute major depressive disorder (MDD) versus placebo (PBO) or standard serotonin-reuptake inhibitors (SRIs) and require review, comparing analytical methods.MethodComputerized searching to identify reports of RCTs of DLX in adult, acute MDD patients permitted meta-analytic pooling to estimate overall response and remission rates, to compare mixed-model, repeated measures (MMRM) versus last-observations-carried-forward (LOCF) analytical methods, and to assess relations of DLX dose to efficacy and adverse outcomes.ResultsWe identified 17 RCTs involving 22 comparisons (DLX versus PBO [n = 17) and DLX versus an SRI [n = 16]), based on MMRM and LOCF methods that allowed estimates of response (>or=50% improvement of depression scores) or remission (final depression score LimitationsRCTs involving DLX are limited, with few direct comparisons to standard antidepressants.ConclusionsDLX has good evidence of efficacy in acute, adult MDD, especially at doses of 80-120 mg/day, but remains inadequately tested against standard alternatives. MMRM analyses yielded slightly superior FLX/PBO contrasts than older LOCF methods.

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