Video: Antidepressants work, but some better than others

9 July 2018

Depression is one of the largest public health issues. Every year around one million Australians experience depression and it is said to cost the country’s economy $12.6 billion dollars a year. Equally significant are the individual and personal costs such as loss of motivation, sadness and isolation. For years there’s been debate about how effective antidepressants are at treating major depression, the cost their effect has, and in some cases whether they’re any better than placebo (dummy) pills.

New research has confirmed that antidepressants are more effective than placebo. In this meta-analysis of 522 trials, comprising some 116,000 participants, the researchers looked at whether any one of 21 different types of antidepressant did a better job at treating depression than a placebo. In particular, they were looking at the efficacy of each drug (how many people responded positively to it) and the drug’s acceptability (how many people discontinued treatment - due to any cause, which could include negative side effects). The only trials included in the meta-analysis were double-blind randomised controlled trials.

In terms of efficacy, each of the 21 antidepressants were more effective than the placebo. On the other side of the coin, but as you might expect, all 21 antidepressants were discontinued more often than the placebo due to adverse side effects. The most effective antidepressant was amitriptyline, which was also the sixth-best tolerated. Others that scored well on both efficacy and acceptability were agomelatine, escitalopram, and vortioxetine.

Implications

So what does all that mean for you? The research represents some of the most thorough analysis of available antidepressants to date and by comparing different drugs head-to-head it also allowed the researchers to see which performed best, and where. The research has clinical implications for any doctor looking to prescribe an antidepressant for a patient, and could empower consumers to ask questions of their doctor about the drug they’re being prescribed, why that drug in particular has been chosen and if a better alternative might be available.

Last Reviewed: 9 July 2018
© Norman Swan Medical Communications.

References

Cipriani, et al. (2018). 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 doi: 10.1016/S0140-6736(17)32802-7