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Aim: To evaluate the effectiveness of serotonin-norepinephrine reuptake inhibitors (SNRI) compared to selective serotonin reuptake inhibitors (SSRI) for induction of remission in major depressive disorder.Data sources: PubMed, evidence-based medicine databases and Index de Revistas Medicas Portuguesas.Review methods: We searched guidelines, systematic reviews and meta-analyses published before 13th January 2013 and randomized clinical trials published between 1st January 2011 and 13th January 2013, using the MeSH terms depressive disorder, major; venlafaxine; duloxetine. Portuguese descriptors depressao and antidepressivos de segunda geracao were also used. We used the Strength of Recommendation Taxonomy (SORT) from the American Family Physician for classifying the levels of evidence and the strength of recommendations.Results: 223 articles were found. Three guidelines, nine systematic reviews and meta-analyses were selected. No RCT were found meeting the inclusion criteria. Both SNRI and SSRI are considered first-line therapeutic choices (level of evidence [LE] 1) and there is no clear evidence for the superiority of SNRI over SSRI (LE 2). There is consistent evidence for the higher efficacy of venlafaxine over fluoxetine and paroxetine (LE 2). Guidelines highlight the importance of choosing an antidepressant by considering tolerability and patient-related aspects (LE 1).Conclusions: SNRI and SSRI are both evidence-based choices for induction of remission in depression (strength of recommendation [SOR] A). Drug and patient characteristics must be taken into account when choosing the antidepressant (SOR A). In a patient without co-morbidities, some SNRI show higher efficacy in remission of depression, but we cannot talk about a class effect. The choice of a SNRI over a SSRI to achieve remission of depression is not supported by the current evidence (SOR B).

Comparação entre SNRI e SSRI na indução da remissão da perturbação depressiva major: uma revisão baseada na evidência