LONDON, Feb 23 ― After much debate, a new review of research has concluded that antidepressants are more effective than a placebo for short-term treatment of acute depression in adults.
Led by researchers at the University of Oxford, UK, the new meta-analysis is the largest ever in psychiatry, analysing 522 trials and a total of 116,477 participants to look at the effectiveness of antidepressants compared to a placebo.
The trials compared 21 commonly used antidepressants with a placebo, or with other antidepressants, which were used for the acute treatment (over 8 weeks) of moderate to major depression in adults aged 18 years or older.
The team also included the largest amount of unpublished data to date on the effectiveness of the drugs.
They found that all 21 antidepressants were more effective than a placebo. Two drugs (agomelatine and fluoxetine) appeared to be better tolerated than placebo, with less dropouts due to side effects, and only one drug (clomipramine) was more poorly tolerated than placebo.
Effectiveness ranged from small to moderate for different drugs, with some antidepressants more effective than others.
Agomelatine, amitriptyline, escitalopram, mirtazapine, paroxetine, venlafaxine, and vortioxetine were found to be most effective, while fluoxetine, fluvoxamine, reboxetine, and trazodone were least effective.
Antidepressants differed in terms of how tolerable they were, with agomelatine, citalopram, escitalopram, fluoxetine, sertraline, and vortioxetine proving most tolerable, and amitriptyline, clomipramine, duloxetine, fluvoxamine, reboxetine, trazodone, and venlafaxine being least tolerable.
Lead author Dr Andrea Cipriani outlined, “Our findings are relevant for adults experiencing a first or second episode of depression ― the typical population seen in general practice.”
However, Dr Cipriani added, “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.”
“Medication should always be considered alongside other options, such as psychological therapies, where these are available. Patients should be aware of the potential benefits from antidepressants and always speak to the doctors about the most suitable treatment for them individually.”
The authors also pointed out the data included in the meta-analysis only covered 8 weeks of treatment, so results may not be applicable to longer-term antidepressant use. The team were also unable to look at effectiveness or acceptability of antidepressants in relation to age, sex, severity of symptoms, duration of illness or other factors that would influence results at an individual level.
The team disclosed that 409 (78 per cent) of 522 trials were funded by pharmaceutical companies, with overall 46 (9%) trials rated as high risk of bias, 380 (78 per cent) as moderate, and 96 (18 per cent) as low. However, the design of the meta-analysis and the inclusion of previously unpublished data attempted to reduce the impact of bias as much as possible.
An estimated 350 million people have depression globally, with the condition the leading cause of disability across the world.
The results can be found online published in The Lancet. ― AFP-Relaxnews
