![]() ![]() ![]() Drop-out rates by eight weeks of treatment were similar to placebo for the majority of antidepressants. ![]() The least effective was the serotonin and noradrenaline reuptake inhibitor reboxetine, which increased treatment response by 37% (OR 1.37, 95% CrI 1.16 to 1.63). The most effective antidepressant compared to placebo was the tricyclic antidepressant amitriptyline, which increased the chances of treatment response more than two-fold (odds ratio 2.13, 95% credible interval 1.89 to 2.41). All 21 antidepressants were more likely to produce a treatment response after eight weeks treatment than a placebo.However, the trials were all placebo controlled. ![]() They found 380 trials at possible risk of bias due mainly to lack of reporting of randomisation methods, and 46 at high risk. The antidepressants were compared for effectiveness (at least 50% improvement in symptoms) and acceptability (assessed as drop-out rate). As well as publication databases, international trial registers and drug approval websites, the researchers had contacted all pharmaceutical companies marketing antidepressants to ask for unpublished studies. More than 100 trials were previously unpublished. They included 522 double-blind randomised controlled trials of 116,477 adults with moderate to severe depression. This systematic review and network meta-analysis compared 21 antidepressants with placebo or each other, directly within trials and indirectly across trials. This new analysis went to some lengths to find unpublished studies and additional data from published studies, to give us the best overview of the current state of research. One 2008 meta-analysis suggested that antidepressants gave little benefit over placebo for mild to moderate depression. Their mode of action is poorly understood, and improvement in mood tends to be modest. There has been uncertainty in recent years about the effectiveness of antidepressants. There is conflicting evidence to guide which antidepressants should be prescribed first-line, although NICE recommends a selective serotonin reuptake inhibitor (SSRI). Antidepressants are widely prescribed in primary and secondary care, along with psychological interventions such as cognitive behavioural or interpersonal therapy. It is extensive, included only placebo controlled double blind trials and searched successfully for unpublished trials.ĭepression is a common condition, affecting an estimated 1 in 10 adults at some point in their lives. Though there are some concerns over items not reported by individual trials, this review is likely to be reliable. However, it did not assess antidepressants compared to other treatments such as cognitive behavioural therapy, or treatments in combination. The review provides new evidence which may help people decide which antidepressant to choose first-line for moderate to severe depression. Several drugs were more effective and were stopped by fewer people than others: Researchers ranked drugs by effectiveness and acceptability after eight weeks of treatment. Five antidepressants appear more effective and better tolerated than others.Ī major review of 522 antidepressant trials found that all of the 21 drugs studied performed better than placebo, in short-term trials measuring response to treatment. This is a plain English summary of an original research articleĪntidepressants are effective to treat moderate to severe depression in adults. ![]()
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