Antidepressants More Effective Than Placebo for Acute Depression in Adults

Prozac thought to be the most widely used antidepressant in history is 52 per cent more effective than a placebo

"It puts to bed the idea that antidepressants don't work - all 21 antidepressants were more effective than placebo at treating depression".

Glyn Lewis, professor of psychiatric epidemiology at University College London, said the "excellent" study provided "compelling evidence" for the effectiveness of anti-depressants.

"By bringing together published and unpublished data from over 500 double-blind randomized controlled trials, this study represents the best now available evidence base to guide the choice of pharmacological treatment for adults with acute depression".

"The large amount of data allowed more conclusive inferences and gave the opportunity also to explore potential biases".

Although important, these results do not answer the question about the long-term effects of antidepressants, and a network meta-analysis approach can not be used on the individual patient level, Sagar V Parikh, MD, department of psychiatry, University of MI, and Sidney H Kennedy, MD, department of psychiatry, University of Toronto, wrote in an accompanying comment.

Twenty-one commonly used antidepressant medications appeared more effective than placebo for the treatment of major depressive disorder in adults, according to findings from an worldwide study. A total of 87,052 participants were randomly assigned to receive a medication and 29,425 were randomly assigned to receive placebo.

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The trials included in the analysis, which represented data on 116,477 patients, assessed oral monotherapy of antidepressants for the acute treatment of adults with major depressive disorder. Studies including individuals with bipolar depression, psychosis, or treatment-resistant depression were excluded from the analysis. The results showed that all 21 antidepressant medications were more effective than placebo, with odds ratios ranging between 2.13 for amitriptyline and 1.37 for reboxetine. The most effective were Agomelatine (sold under several brand names, including Valdoxan, Melitor and Thymanax), amitriptyline (Elavil), escitalopram (Lexapro), mirtazapine (Remeron), paroxetine (Paxil), venlafaxine (Effexor XR) and vortioxetine (Trintellix). "Antidepressants can be an effective tool to treat major depression, but this does not necessarily mean that antidepressants should always be the first line of treatment", Cipriani said in a press release.

The most acceptable antidepressants were agomelatine, citalopram, escitalopram, fluoxetine, sertraline, and vortioxetine, and the least acceptable antidepressants were amitriptyline, clomipramine, duloxetine, fluvoxamine, reboxetine, trazodone, and venlafaxine. Investigators of that study noted this may be because depression in children and adolescents may be due to different mechanisms or causes.

Researchers added that most of the data in the meta-analysis covered eight weeks of treatment, so the findings might not apply to longer-term use. To minimize bias in the data the study's authors contacted pharmaceutical companies and individual researchers to include a vast array of unpublished data in the calculations.

But it also showed big differences in how effective each drug is. Dr Andrea Cipriani, lead author of paper, said the findings were key to helping both patients and doctors treat depression.

Cipriani disclosed support from the National Institute for Health Research Oxford Cognitive Health Clinical Research Facility.

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