Evidence on the advantages and acceptability of antidepressants

An international study co-led by the University of Bern offers important insights from a synthesis of 522 clinical studies. The results show differences in efficacy of the 21 most commonly used antidepressants worldwide.

Major depressive disorder is one of the most common, burdensome, and costly psychiatric disorders worldwide in adults. Pharmacological and non-pharmacological treatments are available; however, antidepressants are used more frequently than behavioural therapies. Prescription of these agents should be informed by the best available evidence. There is a debate among clinicians and researchers regarding the effectiveness and potential differences of pharmacological interventions for treating patients with major depressive disorder. Given the numerous antidepressants available in the market and the plethora of studies comparing them, it is challenging to grasp a clear picture of the relative efficacy-safety profile of the different options.

To optimally inform practice and mental health policies, Professors Georgia Salanti and Matthias Egger from the Institute of Social and Preventive Medicine of the University of Bern together with colleagues from the Universities of Oxford and Kyoto identified and synthesized data from 522 trials published between 1979 and 2016 involving in total 116 477 participants. Using an advanced statistical technique, called network meta-analysis, they compared the efficacy and acceptability of 21 commonly used antidepressants for major depression among adults. Their findings were published in The Lancet.

Their results suggest that all 21 antidepressants are more efficacious than placebo. There were small but clinically important differences among them in terms of efficacy and acceptability. While certain drugs showed comparatively favorable balance in terms of overall response to treatment and dropout rate, others were less so.

Professors Salanti and Egger hope that the evidence from this large synthesis of studies will help guideline developers forming relevant recommendations and mental health professionals and their patients making informed treatment decisions. Even though differences between antidepressants are small, they are clinically significant and should be considered when making optimal treatment choices. «With this analysis, we offer the best possible evidence for patients and doctors to decide the optimal treatment for patients suffering from major depression», adds Salanti.



Andrea Cipriani, Toshi A Furukawa, Georgia Salanti, Anna Chaimani, Lauren Z Atkinson, Yusuke Ogawa, Stefan Leucht, Henricus G Ruhe, Erick H Turner, Julian P T Higgins, Matthias Egger, Nozomi Takeshima, Yu Hayasaka, Hissei Imai, Kiyomi Shinohara, Aran Tajika,
John P A Ioannidis, John R Geddes: 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, The Lancet, 21 February 2018, http://dx.doi.org/10.1016/ S0140-6736(17)32802-7