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April 17, 2002

Is One Selective Serotonin Reuptake Inhibitor Better Than Another?

Author Affiliations

Stephen J.LurieMD, PhD, Senior EditorIndividualAuthor

JAMA. 2002;287(15):1935-1938. doi:10.1001/jama.287.15.1935

To the Editor: We wish to raise 2 statistical issues regarding the trial reported by Dr Kroenke and colleagues,1 who found that fluoxetine, sertraline, and paroxetine were equally efficacious in treating depression. The authors conclude that " . . . results unequivocally demonstrate the lack of differences among 3 SSRIs across a broad range of outcomes." There are a number of things that the authors must do before the reader can endorse the adverb "unequivocally." First, it would be helpful if the authors could provide a measure of the variance in the 3- and 9-month change scores for each outcome in Tables 2 and 3. This is especially important because no P values are provided. Second, in evaluating the significance of all but the primary outcome, the authors reported only adjusted P values using the Sidak method for multiple comparisons. Based on this multiplicity adjustment, no significant treatment × month interactions were found. We request that the authors report unadjusted (comparisonwise) P values in Tables 2 and 3 since the Sidak correction for multiplicity may be overly conservative if the outcome measures being evaluated are correlated (as functional status measures are) and if the number of outcome measures being corrected for is relatively large (in this case, n = 16 and n = 9 for 2 separate corrections).2-4