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24 February 2018, 06:46 | Louis Holland
Prozac thought to be the most widely used antidepressant in history is 52 per cent more effective than a placeboGETTY IMAGES
An global study conducted by Oxford University suggests that the 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.
Comparative efficacy and acceptability of 21 antidepressant drugs for the acute treatment of adults with major depressive disorder: a systematic review and network meta-analysis.
The analysis of more than 500 trials found some medications worked better than others, however.
Lead researcher Dr Andrea Cipriani, of Oxford University, told the BBC: "This study is the final answer to a long-standing controversy about whether anti-depressants work for depression".
However, she said: "This does not necessarily mean that antidepressants should always be the first line of treatment".
Professor Hopwood said many Australians still remain unconvinced about the potential benefits of antidepressants.
According to an estimation, nearly 350 million people have depression worldwide. The economic burden in the United States of America alone has been estimated at more than US$210 billion. This is likely in part due to the extremely broad medical definition of "depression"; many people are classified as having the same disorder, even if the underlying biological and social influences causing the illness vary considerably. However, there is considerable debate about their effectiveness. While both pharmacological and psychological treatments are available, only one in six people, with depression in rich countries, gets effective treatment. The authors then contacted pharma companies, original study authors, and regulatory agencies in order to supplement incomplete reports of the original papers, or provide data for unpublished studies.
The review was not able to assess individual data (such as age, sex, length of depression) that might affect which patients respond better to, or are suitable for which treatments. The first three "might be considered first choice" by doctors, they write, although the two most effective drugs - amitriptyline and venlafaxine - might still be first choice for severe depression.
The latest study was a meta-analysis including 522 double-blind placebo/real antidepressant tests done between 1979 and 2016 which compared 21 commonly-used antidepressants or placebo. Professor Carmine Pariante, spokesperson for the Royal College of Psychiatrists, said the analysis "finally puts to bed the controversy on antidepressants, clearly showing that these drugs do work in lifting mood and helping most people with depression".
All 21 antidepressants were more effective than placebos and only one drug (clomipramine) was less acceptable than placebo. Fluoxetine, fluvoxamine, reboxetine and trazodone were the least effective. The majority of the most effective antidepressants are now off patent and available in generic form.
In terms of acceptability, the only antidepressants linked to fewer dropouts than placebo were agomelatine (OR = 0.84; 95% CI 0.72-0.97) and fluoxetine (OR = 0.88; 95% CI, 0.8-0.96); placebo was only considered more acceptable than clomipramine (OR = 1.3; 95% CI, 1.01-1.68). The findings are not applicable to people with treatment-resistant depression.
If cancer or heart patients suffered this level of under-treatment, there would be a public outcry, they say. "With effectiveness ranging from small to moderate for available antidepressants, it's clear there is still a need to improve treatments further", adds Dr Cipriani, .
The team disclosed that 409 (78 per cent) of 522 trials were funded by pharmaceutical companies, with overall 46 (9%) trials rated as high risk of bias, 380 (78 per cent) as moderate, and 96 (18 per cent) as low.
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