CRD Summary: This review concluded that there were no consistent and valid differences to suggest that multiple modes of action improved clinical outcomes between paroxetine and other antidepressants for depressive disorders. This was a generally well-conducted review. The authors' conclusions appear to be reliable.

[Comparative antidepressants included amitriptyline, clomipramine, fluoxetine, imipramine, mirtazapine, sertraline, venlafaxine and others. ]

CRD Commentary: This review addressed a clear question and was supported by appropriate inclusion criteria. Attempts were made to identify all published studies by searching a number of databases and other sources. Unpublished studies were not included in the review, so some relevant studies may have been missed. However, the authors did attempt to assess publication bias and reported no evidence of bias. Validity was assessed according to published criteria. A number of reviewers were involved in the systematic review process, limiting reviewer error and bias. Comprehensive details of the individual trials were reported, with the exception of quality assessment results. It appeared that the trials were appropriately summarised using meta-analyses, although results from statistical tests of heterogeneity were not reported. More detailed analyses of adverse events would have been beneficial to assess the overall clinical effectiveness of the intervention. This was a generally well-conducted review. The authors' conclusions appear to be reliable.