A recent large meta-analysis was carried out to compare and rate the effectiveness of antidepressants for use in adults with depression.

Major depressive disorder is currently one of the most common, troublesome, and costly psychiatric disorders in adults. Treatments available for major depressive disorder can be split into two broad categories: pharmacological and non-pharmacological. The economic cost of depressive disorder in the USA has been estimated to be over $210 billion, with 45% being direct costs, 5% associated with suicide, and 50% to workplace costs. It has also been estimated that 350 million people are affected by major depressive disorder across the world. This presents a large challenge to current health systems in both developed and developing countries, with the desperate need to treat patients, maximise resources, and improve the overall mental health care available to the public.

The most frequently used treatments for major depressive disorder are antidepressants. Despite the large-scale use of these antidepressants, there has been much debate in the literature regarding their effectiveness as a group, and also with regards to the possible differences in effectiveness and tolerability between these various antidepressants.

As a result of the ever-increasing number of trials published and new antidepressants being marketed, a recent updated systematic review and meta-analysis of these drugs was carried out and published in The Lancet. A large international research team including scientists from the USA, Japan, France, Germany, the UK, and the Netherlands contributed to this project.

Within this systematic review and meta-analysis, 28,552 citations were identified which consisted of 552 trials which included 116,477 participants. The main finding of this review was that all antidepressants were more effective than placebo in adults when treating major depressive disorder. The results also demonstrated that in head-to-head studies the most effective antidepressants were agomelatine, amitriptyline, escitalopram, mirtazapine, paroxetine, venlafaxine, and vortioxetine; with fluoxetine, fluvoxamine, reboxetine, and trazodone being the least efficacious drugs. With regards to tolerability, agomelatine, citalopram, escitalopram, fluoxetine, sertraline, and vortioxetine were tolerated better than other antidepressants.

The results of this recent and updated systematic review and meta-analysis provide evidence that can inform and guide patients, physicians, and policy developers on the efficacy of various antidepressants. Future research is required in order to add to this current network meta-analysis in order to combine group and individual patient data. This analysis provides clinicians with the ability to predict personalised clinical outcomes including side-effects, early response and to estimate the efficacy at each time point.

Written by Jade Marie Evans, MPharm, Medical Writer

Reference: Cipriani. A et al. (2018). 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. Available: Last accessed 7th Mar 2018

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