Medicine

More people need anti-depressants, study finds

More people need anti-depressants, study finds

The authors note that the data cover only eight weeks of treatment so may not necessarily apply to longer-term antidepressant use. The majority of the most effective antidepressants are now available in generic form. The researchers identified all trials that were conducted between 1979 and 2016 that compared commonly used antidepressants with placebo or with other antidepressants for the acute treatment (over 8 weeks) of major depression in adults aged 18 or older. A new meta-analysis of over 500 trials covering the largest dataset evaluated to date has concluded that antidepressants are definitely more effective than a placebo. "Nevertheless, Cipriani and colleagues have made a major contribution", they wrote. "Network meta-analyses of existing datasets make it possible to estimate comparative efficacy, summarise and interpret the wider picture of the evidence base, and to understand the relative merits of the multiple interventions".

Mr Cipriani added that the findings do not mean that antidepressants should always be the first line of treatment. Do more people need to be on antidepressants, or should people be looking at other ways to overcome depression?

In regards to acceptability - the study's other primary endpoint - measured by the treatment discontinuation due to study withdrawal, only agomelatine (OR 0.84, 95% CI 0.72-0.97) and fluoxetine (OR 0.88, 95% CI 0.80-0.96) were linked to fewer dropouts compared with placebo, while clomipramine (OR 1.30, 95% CI 1.01-1.68) had a higher dropout rate than placebo.

Debate over the efficacy of antidepressants has raged for years with a torrent of studies, often quite convincingly, arguing that the drugs are no better than a placebo, and research pointing to the contrary inevitably stained by pharmaceutical company bias.

Among the least tolerable are amitriptyline, clomipramine, duloxetine, fluvoxamine, reboxetine, trazodone and venlafaxine, with clomipramine proving less acceptable than placebo.

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The antidepressants displaying the most effective results were agomelatine, amitriptyline, escitalopram, mirtazapine, paroxetine, venlafaxine, and vortioxetine, while the least effective drugs were fluoxetine, fluvoxamine, reboxetine, and trazodone.

This study is an worldwide network meta-analysis that included 522 double-blind, randomized, controlled trials with 116,477 participants.

The study had some limitations, including the fact that many trials analyzed did not report adequate information about randomization and allocation concealment. The researchers were also unable to tease apart differences among groups of people in the studies-for instance, how the drugs worked for people of different ages or gender. About a third of people with depression do not respond to treatment.

After the largest-ever study, the Oxford University-led team said they had wanted to "give the final answer" to the controversy of whether or not the pills effectively treat depression.

Disclosures: Cipriani reports support from the National Institute for Health Research Oxford Cognitive Health Clinical Research Facility. TAF has received lecture fees from Eli Lilly, Janssen, Meiji, Mitsubishi-Tanabe, Merck Sharp & Dohme, and Pfizer; consultancy fees from Takeda Science Foundation; and research support from Mochida and Mitsubishi-Tanabe. Other co-authors disclosed multiple relevant relationships with industry.


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