BMJ: ‘Adding a sulfonylurea to metformin looks safer than switching to one’

BMJ: ‘Adding a sulfonylurea to metformin looks safer than switching to one’

July 25 2018 Switching to sulfonylureas in type 2 diabetes has been linked with an increased risk...

DOACs associated with reduced risk of major bleeding compared to warfarin

DOACs associated with reduced risk of major bleeding compared to warfarin

July 11 2018 Direct oral anticoagulants (DOACs) have been associated with reduced risks of major...

Recorded penicillin allergy associated with increased risk of MRSA and C difficile

Recorded penicillin allergy associated with increased risk of MRSA and C difficile

July 3 2018 People who have a record of penicillin allergy are at an increased risk of developing...

Syphilis and gonorrhoea diagnoses see significant increase

Syphilis and gonorrhoea diagnoses see significant increase

June 11 2018 Annual reporting of sexually transmitted infection diagnoses has increased 0.3% in...

Anticholinergics linked to increased risk of dementia

Anticholinergics linked to increased risk of dementia

April 30 2018 Anticholinergic drugs used in helping control some involuntary muscle movement...

  • BMJ: ‘Adding a sulfonylurea to metformin looks safer than switching to one’

    BMJ: ‘Adding a sulfonylurea to metformin looks safer than switching to one’

    Wednesday, 25 July 2018 13:55
  • DOACs associated with reduced risk of major bleeding compared to warfarin

    DOACs associated with reduced risk of major bleeding compared to warfarin

    Wednesday, 11 July 2018 13:11
  • Recorded penicillin allergy associated with increased risk of MRSA and C difficile

    Recorded penicillin allergy associated with increased risk of MRSA and C difficile

    Tuesday, 03 July 2018 16:42
  • Syphilis and gonorrhoea diagnoses see significant increase

    Syphilis and gonorrhoea diagnoses see significant increase

    Monday, 11 June 2018 14:16
  • Anticholinergics linked to increased risk of dementia

    Anticholinergics linked to increased risk of dementia

    Monday, 30 April 2018 12:08

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
More inWhite Papers  

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.

Clinical News

July 31 2018 General practices employing pharmacists are citing improved capacity to see patients and workload changes as the main benefits of the scheme.
July 25 2018 Switching to sulfonylureas in type 2 diabetes has been linked with an increased risk of complications compared with staying on metformin, a BMJ study has concluded. However, the study has...