A systematic review and network meta-analysis, published in The Lancet, evaluating 21 antidepressants has proven the efficacy of treatment versus placebo in adults with major depressive disorder.
Happy pills
The international team of researchers, led by Dr Andrea Cipriani (NIHR Oxford Health Biomedical Research Centre), searched through multiple databases to find any trials involving antidepressant therapies up until 8 January 2016. Exclusion criteria comprised quasi-randomised trials and trials that were incomplete or included a fifth or more of participants with bipolar disorder, psychotic depression, or treatment-resistant depression, or patients with a serious concomitant medical illness.
Through this search, the team found nearly 30,000 citations. These included more than 500 trials and more than 116,000 trial participants.
Antidepressants included in this study were either compared with a placebo or with another antidepressant in a head-to-head format. Primary outcomes were efficacy and acceptability of treatment.
After considering all the trials, the team discerned that all 21 antidepressants were more effective than placebo in the treatment of patients with major depressive disorder. When looking at the head-to-head comparisons, it was found that agomelatine, amitriptyline, escitalopram, mirtazapine, paroxetine, venlafaxine and vortioxetine were the most effective drugs. Fluoxetine, fluvoxamine, reboxetine and trazodone were the least effective.
When looking at the acceptability of the treatments (the dropout rates per treatment) agomelatine, citalopram, escitalopram, fluoxetine, sertraline, and vortioxetine were the most tolerated. Amitriptyline, clomipramine, duloxetine, fluvoxamine, reboxetine, trazodone and venlafaxine were the least tolerated and had the highest dropout rates.
Although these studies indicated overall effectiveness and acceptability of the treatment, the authors explained that each therapy may find use and is dependent on the individual case.
“This study is the final answer to a long-standing controversy about whether anti-depressants work for depression,” revealed Cipriani, when discussing her study with the BBC. “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.”
Speaking to The Guardian Professor Carmine Pariante, spokesperson for the Royal College of Psychiatrists, said the analysis “finally puts to bed the controversy on antidepressants, clearly showing that these drugs do work in lifting mood and helping most people with depression. Importantly, the paper analyses unpublished data held by pharmaceutical companies, and shows that the funding of studies by these companies does not influence the result, thus confirming that the clinical usefulness of these drugs is not affected by pharma-sponsored spin.”