Major study finds that antidepressants are effective

Joy Montgomery
February 24, 2018

This is usually the best way to assess the available medical research or evidence on a topic, but a meta-analysis is only as good as the trials that it includes. This included 101 previously unpublished studies. There are still significant voids in our understanding of depression, but this should ease the mind of both doctors administering and patients taking the antidepressants. Some are more effective than others, but all were more effective than a placebo, and even a placebo was better than nothing.

Andrea Cipriani, from the university's Department of Psychiatry, said: "Under-treated depression is a huge problem and we need to be aware of that".

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".

They warn that their findings "comparing the merits of one antidepressant with another must be tempered by the potential limitations of the methodology", and must take account of differences between patients and their circumstances.

Depression affects around 300 million people across the world, according to the World Health Organisation. The economic burden in the U.S. alone has been estimated at more than US$210 billion.

More information about depression is available at Beyond Blue. However, there is considerable debate about their effectiveness.

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It has been suggested a million more people per year in the United Kingdom should be given access to treatment for depression, through either drugs or talking therapies, with scientists saying the study proves drugs do work. Importantly, the paper analyses unpublished data held by pharmaceutical companies, and shows that the funding of studies by these companies does not influence the result, thus confirming that the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.

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".

All 21 antidepressants were more effective than placebos and only one drug (clomipramine) was less acceptable than placebo.

However, some are more effective than others, with agomelatine, amitriptyline, escitalopram, mirtazapine, paroxetine, venlafaxine and vortioxetine proving most effective, and fluoxetine, fluvoxamine, reboxetine and trazodone the 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.

The data involves meta-analysis covers 8-weeks of treatment. They included clinical trials that compared 21 commonly used antidepressant medications or placebo in their network meta-analysis; overall, 87,052 participants received an antidepressant drug and 29,425 received placebo. Trials with patients who also had bipolar depression, symptoms of psychosis or treatment resistant depression were excluded. And while antidepressants are a common form of treatment, around a third of the people who take them don't respond to treatment. "It's clear there is still a need to improve treatments further".

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.

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