In head-to-head studies, agomelatine, amitriptyline, escitalopram, mirtazapine, paroxetine, venlafaxine, and vortioxetine were more effective than other antidepressants, whereas fluoxetine, fluvoxamine, reboxetine, and trazodone were the least efficacious drugs, the researchers noted. From a scientific perspective though, they're highly contested.
Quashing speculation if antidepressants really do work, a landmark study has suggested that antidepressant drugs are more effective than placebos in treating depression.
After considering all the trials, the team discerned that all 21 antidepressants were more effective than placebo in the treatment of patients with major depressive disorder. 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. "Patients should be aware of the potential benefits from antidepressants and always speak to the doctors about the most suitable treatment for them individually".
The debate over antidepressants has unfortunately often been ideological, said Cipriani. Through the Freedom of Information Act, the FDA demands pharmaceutical companies provide data on all the clinical trials they sponsor - including unpublished trials.
However, this study is unlikely to end controversy and accusations of bias on either side and it won't settle the debate. Pharmaceutical companies funds the majority of studies on antidepressants, and they have a clear financial interest in the success of these drugs. Pharmaceutical companies have very little incentive to publish trials with negative results, and journals also nearly never publish negative results, so published results are skewed towards positivity.
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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". "Forty-six (9%) of 522 trials were rated as high risk of bias, 380 (73%) trials as moderate, and 96 (18%) as low", note the authors. By clarifying which antidepressants are most effective, and which ones patients find easiest to take, this new work will greatly help clinicians and patients in those decisions'.
The research should reassure patients and doctors, she said. "Differences between antidepressants are smaller, although newer drugs tend to be better tolerated".
Researchers sought to use the findings to overcome "ideological" opposition to the treatment of depression with drugs.
Other experts said the study was of major importance.
Each of the 21 antidepressants was more viable than fake treatment, and just a single medication (clomipramine) less satisfactory than fake treatment. Contemporary western psychiatry relies heavily on antidepressants to treat depression and presents it as the most scientific, enlightened approach to the illness. It is a respiratory depressant and can cause overdose. From a strictly scientific perspective, though, the evidence is pretty mixed.