New meta-analysis shows no substantial differences between second generation antidepressants for depression


A large number of systematic reviews and guidelines have been published in recent years to assist clinicians in prescribing the best antidepressants for treating depression. This new meta-analysis conducted by researchers from Austria and the US, sets out to compare the benefits and harms of second generation antidepressant drugs in the treatment of major depressive disorder.

The research team conducted a systematic search of databases and various sources of unpublished data. For the assessment of efficacy, they sought head-to-head RCTs of at least 6 weeks’ duration comparing two drugs (placebo-controlled studies were included for indirect comparisons). For harms, they examined data from both RCTs and observational studies (including at least 1,000 patients, with follow-up of ≥12 weeks).

They included 234 trials in total, 118 of which were head-to-head studies. Unsurprisingly, the majority of trials included were sponsored by the pharmaceutical industry.

Here’s what they found:

  • No clinically relevant differences in efficacy or effectiveness were detected for the treatment of acute, continuation and maintenance phases of major depressive disorder
  • No differences in efficacy were seen in patients with accompanying symptoms or in subgroups based on age, sex, ethnicity, or comorbid conditions
  • Individual drugs differed in onset of action, adverse events, and some measures of health-related quality of life

The authors concluded:

Current evidence does not warrant recommending a particular second-generation antidepressant on the basis of differences in efficacy. Differences in onset of action and adverse events may be considered when choosing a medication.

Prescribers of antidepressants may be interested in the comparative adverse events table found on page 780 of the paper (see PDF link below).

Gartlehner G, Hansen RA, Morgan LC, Thaler K, Lux L, Van Noord M, Mager U, Thieda P, Gaynes BN, Wilkins T, Strobelberger M, Lloyd S, Reichenpfader U, Lohr KN. Comparative Benefits and Harms of Second-Generation Antidepressants for Treating Major Depressive Disorder: An Updated Meta-analysis (PDF). Ann Intern Med. 2011 Dec 6;155(11):772-85.

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Andre Tomlin

André Tomlin is an Information Scientist with 20 years experience working in evidence-based healthcare. He's worked in the NHS, for Oxford University and since 2002 as Managing Director of Minervation Ltd, a consultancy company who do clever digital stuff for charities, universities and the public sector. Most recently André has been the driving force behind the Mental Elf and the National Elf Service; an innovative digital platform that helps professionals keep up to date with simple, clear and engaging summaries of evidence-based research. André is a Trustee at the Centre for Mental Health and an Honorary Research Fellow at University College London Division of Psychiatry. He lives in Bristol, surrounded by dogs, elflings and lots of woodland!

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