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Umesh Modi is a chartered accountant, and Pamini Jatheeskumar is a chartered certified accountant at Silver Levene...
  Don Lavoie is alcohol programme manager at Public Health England and Gul Root is lead...
Don Lavoie is alcohol programme manager at Public Health England and Gul Root is lead pharmacist, Health and Wellbeing Directorate, Public Health England
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a person taking pills imageFebruary 23 2018

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

Analysis of 680 studies found that when 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 0·84) and fluoxetine (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 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.”

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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