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a man taking medication imageFebruary 23 2018

A meta-analysis of data on 21 antidepressants from 680 studies has concluded that all are more efficacious than placebo in adults with major depressive disorder.

Compared to placebo amitriptyline had the highest odds ratio (OR) of 2·13 for effectiveness, while reboxetine had an OR of 1·37.

In terms of acceptability, the researchers found that only agomelatine with an OR of 0·84and fluoxetine with OR of 0·88 “were associated with fewer dropouts than placebo”, whereas clomipramine was found to be worse than placebo with an OR of 1·30.

“When all trials were considered, differences in ORs between antidepressants ranged from 1·15 to 1·55 for efficacy and from 0·64 to 0·83 for acceptability,” said the researchers.

Agomelatine, amitriptyline, escitalopram, mirtazapine, paroxetine, venlafaxine, and vortioxetine were found to be more effective than other antidepressants in head-to-head studies.

Fluoxetine, fluvoxamine, reboxetine, and trazodone were considered to be the least efficacious drugs when compared to others.

Antidepressants that were considered to have the most acceptability were agomelatine, citalopram, escitalopram, fluoxetine, sertraline, and vortioxetine were more tolerable, while “amitriptyline, clomipramine, duloxetine, fluvoxamine, reboxetine, trazodone, and venlafaxine had the highest dropout rates.”

The study notes that psychiatric disorders account for 22.8% of the global burden of diseases, with depression the leading cause of disability within that.

Lead author on the study, Dr Andrea Cipriani, Associate Professor, in the Department of Psychiatry at the University of Oxford, said: “Antidepressants are an effective tool for depression. Untreated depression is a huge problem because of the burden to society.

“This study is the final answer to a long-standing controversy about whether anti-depressants work for depression. We found the most commonly prescribed anti-depressants work for moderate to severe depression and I think this is very good news for patients and clinicians.”

Responding to the study, Professor Helen Stokes-Lampard, RCGP Chair said: “Taking antidepressants is frequently portrayed as a negative thing or something done only when other therapies are not available or have failed, but this in itself can add to the unfortunate stigma that sometimes exists around people with mental health conditions.

“This research should reassure patients who are taking or are contemplating commencing antidepressants, and the doctors that prescribe them, that they are an effective treatment for depression in the short-term.”

She added: “Although antidepressants are of proven benefit – as this study shows – no doctor wants their patients to become reliant on medication so where possible, GPs will explore alternative treatments, such as talking therapies or CBT, which can be of great benefit for some patients.”

Link:
A Cipriani et al. ‘Comparative efficacy and acceptability of 21 antidepressant drugs for the acute treatment of adults with major depressive disorder: a systematic review and network meta-analysis’. The Lancet. Published online February 22 2018.

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