Anti-depressants equally effective
01-January-2012
There is nothing to pick between the second-generation antidepressants in their efficacy for treating major depression, a large meta-analysis confirms.
Doctors should instead choose an antidepressant based on patient preference and tolerability, and ensure they are familiar with a wide range of different agents, researchers said.
They reviewed 234 studies on the efficacy of SSRIs, SNRIs, bupropion, mirtazipine, nefazodone and trazodone — for acute, continuation and maintenance therapy in major depressive disorder. Some studies compared agents directly; others indirectly.
Overall they found “no substantial differences” in clinical efficacy between any of the drugs, in any phase of treatment.
This was in contrast to a 2009 meta-analysis, which had concluded escitalopram and sertraline had the best ratio of efficacy to acceptability.
However the present authors said the earlier meta-analysis had “methodological shortcomings”, such as its inclusion of highly bias-prone studies which were excluded from the current analysis.
“Given the difficulty in predicting what medication will be both efficacious for and tolerated by an individual patient, familiarity with a broad spectrum of antidepressants is prudent,” the US and Austrian authors wrote last week in the Annals of Internal Medicine.
“Existing evidence of efficacy, however, does not warrant choosing a particular second-generation antidepressant as first line therapy for acute-phase major depressive disorder or as a subsequent treatment in patients who do not respond to therapy or experience remission.
“Because of differences in adverse events and dosing regimens, engaging in informed decision making can help physicians to take patient preferences into consideration.”
First seen in Psychiatry Update
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