Large meta-study concludes antidepressants are more effective than a placebo

A woman showing signs of depression

Although antidepressants are considered to be efficient and the US Food and Drug Administration has approved them as a suitable treatment for depression, researchers are still trying to prove that they are more effective than other methods (Placebo is the most popular alternative). "We don't have any very precise treatments for depression at this point in time", said Geddes.

"Medication should always be considered alongside other options, such as psychological therapies, where these are available".

Globally, more than 300 million people of all ages suffer from depression, according to the World Health Organization.

With one exception, clomipramine, all of the drugs tested in the trials were found to be more effective than a placebo.

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The full paper, 'Comparative efficacy and acceptability of 21 antidepressant drugs for the acute treatment of adults with the major depressive disorder: a systematic review and network meta-analysis', can be read in The Lancet.

Scientists during the study identified all double-blind, randomized controlled trials (RCTs). 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.

"By bringing together published and unpublished data from over 500 double blind randomized controlled trials, this study represents the best now available evidence base to guide the choice of pharmacological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", says co-author Professor John Ioannidis. The best at treating depression were Agomelatine (under several brand names, including Valdoxan, Melitor and Thymanax), amitriptyline (Elavil), escitalopram (Lexapro), mirtazapine (Remeron), paroxetine (Paxil), venlafaxine (Effexor XR) and vortioxetine (Trintellix).

"It also challenges the often-held view that all antidepressants are more or less equally effective".

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The research should reassure patients and doctors, she said. The trial data can not show which drug would be likely to work best for any one individual.

Prof Helen Stokes-Lampard, chair of the Royal College of Global Positioning System, said taking antidepressants was frequently portrayed as a negative thing "but this in itself can add to the unfortunate stigma that sometimes exists around people with mental health conditions".

"Antidepressants can be an effective tool to treat major depression", adds Cipriani, "but this does not necessarily mean that antidepressants should always be the first line of treatment". "Depression is a significant mental illness which, if left untreated or unmanaged, can cause a huge amount of distress for a patient, their family and friends".

"This rigorous study confirms that antidepressants have an important place in the treatment of depression", Dr James Warner, Reader in Psychiatry, Imperial College London. "It should never be swept under the carpet or ignored".

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Currently, just one in six people with depression are receiving the correct treatment they need in countries such as Australia, Britain and America. To try to mitigate that risk, the authors contacted pharmaceutical companies and the original study authors to ask them to provide data for studies that went unpublished.

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