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No difference in efficacy between antidepressants

GPs are urged to prescribe second-generation antidepressants based on patient preference, side-effects, dosing regimens and cost, as a meta-analysis concludes there are no clinically important differences in efficacy between them.

Researchers reviewed 234 studies published between 1980 and August 2011 comparing second-generation antidepressants for treating major depressive disorder in adults.  They found no clinically relevant differences in efficacy between drugs, even when sex, ethnicity or co-morbid conditions were taken into account.  

Some 37% of patients with major depressive disorder who received first line treatment did not respond within six to 12 weeks and 53% did not achieve remission.

An analysis of head-to-head trials did show statistically significantly greater response rates for some drugs, such as escitalopram, to which 62% of patients responded, compared with 56% for citalopram. But these differences were judged not to be clinically relevant.

But drugs did differ in their onset of action, dosing regimens and adverse effects. Mirtazapine had a faster onset than citalopram, fluoxetine, paroxetine and sertraline, while bupropion caused lower rates of sexual dysfunction than escitalopram, fluoxetine, paroxetine and sertraline.

Study leader Dr Gerald Gartlehner, head of the department for evidence-based medicine at Danube University, Austria, said: ‘Because of differences in adverse events and dosing regimens, engaging in informed decision making can help physicians take patient preferences into consideration.'

Ann Intern Med, 6 December 2011

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