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Antidepressants more effective than placebo for acute depression, study finds

All of the most commonly prescribed antidepressants were more effective at treating the symptoms of acute depression in adults than placebo, according to the findings of a major analysis.

The meta-analysis, published this week in the Lancet, looked at over 500 trials including over 116,000 patients with major depressive disorder. The analysis included both placebo-controlled trials and head to head trials, where antidepressants were compared with other antidepressants.

The researchers found that all 21 of the most common antidepressants that they looked at in the study were more effective than placebo for treating acute depression in the first eight weeks of treatment.

Agomelatine and fluoxetine showed the greatest acceptability, with patients 16% and 12% less likely respectively to stop taking their medication compared to placebo. Clomipramine had the worst acceptability, with patients 30% more likely to stop taking it than placebo.

Head to head studies included in the analysis also showed that some antidepressants were more effective than others, with agomelatine, amitriptyline, escitalopram, mirtazapine, paroxetine, venlafaxine and vortioxetine proving the most effective.

Agomelatine was the most acceptable drug when compared to other antidepressants, with amitriptyline, duloxetine and venlafaxine among the least tolerable.

The researchers said in the paper: ‘All antidepressants were more efficacious than placebo in adults with major depressive disorder. These results should serve evidence-based practice and inform patients, physicians, guideline developers, and policy makers on the relative merits of the different antidepressants.’

Dr Andrea Cipriani, lead author and senior clinical researcher at the University of Oxford, said: ‘Our findings are relevant for adults experiencing a first or second episode of depression – the typical population seen in general practice.

‘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.’

RCGP chair Professor Helen Stokes-Lampard said: ‘This research should reassure patients who are taking or are contemplating commencing antidepressants, and the doctors that prescribe them, that they are an effective treatment for depression in the short-term.

‘Although antidepressants are of proven benefit - as this study shows - no doctor wants their patients to become reliant on medication so where possible, GPs will explore alternative treatments, such as talking therapies or CBT, which can be of great benefit for some patients.’

It comes as Public Health England was last month tasked by the Government to include antidepressants in a review into prescription drug addiction.

The Lancet; available online 21st February

Readers' comments (15)

  • So, having been slagged off for years for handing out these drugs like Smarties we are now vindicated . The 1in 4 patients that walk through our doors expecting us to solve their problems have little or no access to talking therapies so our only option is a sympathetic ear and a prescription. If the powers that be could address the multitude of non-medical stressors that cause psychological ill health perhaps our prescribing of these drugs might fall. Until then I suspect we'll continue to use them as long as everyone who's having a bad time heads straight to their GP bypassing family, priests, self help groups etc.

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  • As above good job as we have nothing else to offer acutely.Remember Mrs May'mental health is our priority' what BS.

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  • Nice to see one report of drug being effective. recently we only heard of every thing that they say don't work.

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  • Just to point out that the studies looked at diagnosed depression. Adjustment disorders do not respond to antidepressants. This there is still room for the naysayers

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  • Dr Cipriani, lead author, refers to 'severe depression'- headline to 'acute depression', comment mentions 'established depression'... shome confuzn (Ed) 8 week cut off too....so only prescribe for 56 days to remain evidence based?!?!

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  • All the evidence is that the more severe the depression the more effective antidepressants.
    I can’t find in the study whether the depression was mild moderate or severe but as it is an analysis of many studies they might not have discerned this. Either way, if you fulfill the criteria for depression then antidepressants will be better than a placebo. Thus the first step is to make an accurate diagnosis based on ICD 10 criteria.

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  • Here is the link
    http://www.thelancet.com/journals/lancet/article/PIIS0140-6736(17)32802-7/fulltext

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  • 1990s - Defeat Depression Campaign - “useless GPs are under diagnosing depression and under prescribing antidepressants”
    2000s - The Daily Mail et al - “useless GPs are over diagnosing depression and over prescribing antidepressants “
    2010s - useless GPs were probably getting it right all along. Apology accepted......(except there won’t be one)

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  • Interestingly the RCPsych journal has just published an article by Joanna Moncrief who always seems to be attached to anti ECT anti antidepressant discourse rubbishing antidepressants. So depressing that psychiatrists themselves are adding to the stigma

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  • And misinformation

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