Major study backs efficacy of antidepressants

The drugs do work: anti-depressants should be given to a million more Britons, largest ever review claims

Primary outcomes were efficacy and acceptability of treatment.

Co-author Professor John Ioannidis acknowledged there was much speculation surrounding the effectiveness of anti-depressants, despite millions of people around the world taking the drugs. Crucially, Kirsch's 2008 meta-analysis showing antidepressants are no more effective than placebo included data sent by pharmaceutical companies to the Food and Drug Administration to approve various antidepressants-which Kirsch obtained through the Freedom of Information Act.

However, Dr Cipriani added, "Antidepressants can be an effective tool to treat major depression, but this does not necessarily mean that antidepressants should always be the first line of treatment".

An worldwide study conducted by Oxford University suggests that the antidepressants can be an effective tool to treat major depression, but this does not necessarily mean that antidepressants should always be the first line of treatment.

However, some are more effective than others, with agomelatine, amitriptyline, escitalopram, mirtazapine, paroxetine, venlafaxine and vortioxetine proving most effective, and fluoxetine, fluvoxamine, reboxetine and trazodone the least effective.

Millions more people around the world should be prescribed pills or offered talking therapies, which work equally well for moderate to severe depression, say the doctors, noting that just one in six people receive proper treatment in the rich world - and one in 27 in the developing world. Still, it should be noted that different drugs have different impacts on individuals.

"By bringing together published and unpublished data from over 500 double blind randomized controlled trials, this study represents the best now available evidence base to guide the choice of pharmacological treatment for adults with acute depression", says co-author Professor John Ioannidis. Overall, 9% of the trials included in this meta-analysis were considered as high-risk of bias, 73% as moderate and 18% as low. "Depression causes misery to countless thousands every year and this study adds to the existing evidence that effective treatments are available".

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"Medication should always be considered alongside other options, such as psychological therapies, where these are available". And while antidepressants are a common form of treatment, around a third of the people who take them don't respond to treatment.

Although important, these results do not answer the question about the long-term effects of antidepressants, and a network meta-analysis approach can not be used on the individual patient level, Sagar V Parikh, MD, department of psychiatry, University of MI, and Sidney H Kennedy, MD, department of psychiatry, University of Toronto, wrote in an accompanying comment.

The response to this significant piece of research from other experts in the field has been positive. "Nevertheless, Cipriani and colleagues have made a major contribution", they wrote.

The research should reassure patients and doctors, she said.

Disclosures: Cipriani reports support from the National Institute for Health Research Oxford Cognitive Health Clinical Research Facility. To minimize bias in the data the study's authors contacted pharmaceutical companies and individual researchers to include a vast array of unpublished data in the calculations. He also holds minor equity in Mensante.

Editors note: The headline was revised on February 22.

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