The full paper, 'Comparative efficacy and acceptability of 21 antidepressant drugs for the acute treatment of adults with the major depressive disorder: a systematic review and network meta-analysis', can be read in The Lancet.
The global team of researchers, led by Dr Andrea Cipriani (NIHR Oxford Health Biomedical Research Centre), searched through multiple databases to find any trials involving antidepressant therapies up until 8 January 2016.
'Medication should always be cnsidered alongside other options, such as psychological therapies, where these are available'. Twenty-one commonly-used antidepressants were included in the study and while the results suggested all antidepressants were more effective than a placebo, some drugs were much more effective than others.
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The most famous antidepressant of them all, Prozac - now out of patent and known by its generic name, fluoxetine - was one of the least effective but best tolerated, measured by a low drop-out rate in the trials or fewer side-effects reported.
It has been suggested a million more people per year in the United Kingdom should be given access to treatment for depression, through either drugs or talking therapies, with scientists saying the study proves drugs do work.
According to an estimation, nearly 350 million people have depression worldwide. The fact that the conclusion "antidepressants work" was considered groundbreaking enough to be published in a reputable science journal says a lot about existing uncertainties in the field. "We don't have any very precise treatments for depression at this point in time", said Geddes.
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Antidepressants differed in terms of how tolerable they were, with agomelatine, citalopram, escitalopram, fluoxetine, sertraline, and vortioxetine proving most tolerable, and amitriptyline, clomipramine, duloxetine, fluvoxamine, reboxetine, trazodone, and venlafaxine being least tolerable. The team were also unable to look at effectiveness or acceptability of antidepressants in relation to age, sex, severity of symptoms, duration of illness or other factors that would influence results at an individual level. The results confirmed what was already common knowledge for scientists: antidepressants can lead to the reduction of depressive symptoms during the first eight weeks of administrating. "The choice will need to be made by doctor and patient".
"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. The FDA demands pharmaceutical companies provide data on all the clinical trials they sponsor-including unpublished trials.
Prof Carmine Pariante, Institute of Psychiatry, Psychology and Neuroscience and spokesperson for the Royal College of Psychiatrists, said the study "finally puts to bed the controversy on antidepressants, clearly showing that these drugs do work in lifting mood and helping most people with depression". "It should never be swept under the carpet or ignored". "Unfortunately, we know that about one third of patients with depression will not respond to them", he said.
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