Zhuoyue Wang,1,2,* Hui Li,3,4,* Yimin Kang,1,* Yanlong Liu,5,* Ligang Shan,6 Fan Wang2,4 1Psychosomatic Medicine Research Division, Inner Mongolia Medical University, Huhhot, People’s Republic of China; 2Beijing Hui-Long-Guan Hospital, Peking University, Beijing, People’s Republic of China; 3Department of Biomedical Engineering, College of Future Technology, Peking University, Beijing, People’s Republic of China; 4Xinjiang Key Laboratory of Neurological Disorder Research, The Second Affiliated Hospital of Xinjiang Medical University, Urumqi, People’s Republic of China; 5School of Mental Health, Wenzhou Medical University, Wenzhou, People’s Republic of China; 6Department of Anesthesiology, The Second Affiliated Hospital of Xiamen Medical College, Xiamen, People’s Republic of China*These authors contributed equally to this workCorrespondence: Fan Wang, Beijing Hui-Long-Guan Hospital, Peking University, Beijing, 100096, People’s Republic of China, Tel +86 10 83024429, Fax +86 10 62716285, Email FanWang@bjmu.edu.cnPurpose: Selective serotonin reuptake inhibitors (SSRIs) are the preferred treatments for depression. The most common adverse drug reactions are symptoms involving the digestive system, leading to low compliance in patients with depression. Therefore, it is important to assess the safety of SSRIs with respect to the digestive system. Several meta-analyses have compared the risks of digestive side effects of SSRIs and other antidepressants. We aimed to compare the risks of various SSRIs (fluoxetine, escitalopram, citalopram, paroxetine, and sertraline) for adverse reactions of the digestive system.Methods: Systematic searches returned 30 randomized controlled trials (n = 5004) of five antidepressants and placebos.Results: Fluoxetine had the lowest probability of digestive side effects, ranking fifth at 0.548. Sertraline had the highest probability of digestive side effects, with a probability of 0.611. For gastrointestinal tolerability, escitalopram was better than paroxetine (odds ratio [OR] =0.62, 95% confidence interval [CI] 0.43– 0.87) and sertraline (OR=0.56, 95% CI 0.32– 0.99).Conclusion: Fluoxetine exhibited distinct advantages compared to other SSRIs, while sertraline had the greatest likelihood of digestive system side effects. These findings will help doctors understand the relative advantages of various antidepressants.Keywords: depression, selective serotonin reuptake inhibitors, digestive system side effects, network meta-analysis
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