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To the Editor: We question the main conclusion of Dr Kroenke and colleagues¹ that paroxetine, fluoxetine, and sertraline had similar efficacy for the treatment of depressive symptoms and improvement in health-related quality of life. Although there were no statistically significant differences when the measures were analyzed individually, we noticed a pattern in the outcomes that did not appear to be random.

If there were indeed no differences among outcomes for the 3 medications, then the relative pattern of outcomes should have been distributed randomly across measures; that is, each medication should have produced highest or best scores about as often as each other medication. We tested the hypothesis of random distribution of outcomes by ranking the medications in order of the degree of improvement (at 3- and 9-month follow-up) on each of the outcome measures. A combined analysis of all outcomes (their Tables 2 through 5) is shown in Table . . . [Full Text of this Article]

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Similar Effectiveness of Paroxetine, Fluoxetine, and Sertraline in Primary Care: A Randomized Trial
Kurt Kroenke, Suzanne L. West, Ralph Swindle, Alicia Gilsenan, George J. Eckert, Rowena Dolor, Paul Stang, Xiao-Hua Zhou, Ron Hays, and Morris Weinberger
JAMA. 2001;286(23):2947-2955.
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