Which Antidepressants Are Most Effective?

In a recent network meta-analysis, researchers found that the antidepressants agomelatine, amitriptyline, escitalopram, mirtazapine, paroxetine, venlafaxine, and vortioxetine are more effective than other options and placebo.

For their analysis, the researchers reviewed data from placebo-controlled and head-to-head trials of 21 antidepressants used to treat adults with major depressive disorder (MDD). Data were obtained from Cochrane Central Register of Controlled Trials, CINAHL, Embase, LILACS database, MEDLINE, MEDLINE In-Process, PsycINFO, the websites of regulatory agencies, and international registers.

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Group-level data was used to conduct network meta-analysis, and risk of bias was assessed in accordance with the Cochrane Handbook for Systematic Reviews of Interventions.

Ultimately, the present analysis included data on 116,477 participants included in 522 trials. All antidepressants that were studied were found to be more effective than placebo. The most effective antidepressants were agomelatine, amitriptyline, escitalopram, mirtazapine, paroxetine, venlafaxine, and vortioxetine (range of odds ratios [ORs] 1.19 to 1.96).

In contrast, fluoxetine, fluvoxamine, reboxetine, and trazodone were among the least efficacious antidepressants (range of ORs 0.51 to 0.84).

“All antidepressants were more efficacious than placebo in adults with major depressive disorder,” the researchers wrote. “Smaller differences between active drugs were found when placebo-controlled trials were included in the analysis, whereas there was more variability in efficacy and acceptability in head-to-head trials.

“These results should serve evidence-based practice and inform patients, physicians, guideline developers, and policy makers on the relative merits of the different antidepressants,” they concluded.”

—Christina Vogt

Reference:

Cipriani A, Furukawa TA, Salanti G, et al. 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 [Published online February 21, 2018]. Lancet. https://doi.org/10.1016/S0140-6736(17)32802-7.