A systematic review and network meta-analysis concluded that all 21 antidepressants were more efficacious than placebo in adults with major depressive disorder. Smaller differences between active drugs were found when placebo-controlled trials were included in the analysis, whereas there was more variability in efficacy (response rate) and acceptability (treatment discontinuations due to any cause) in head-to-head trials. The analysis included 522 trials comprising 116 477 participants. When all trials were considered, differences in odd ratios (ORs) between antidepressants ranged from 1·15 to 1·55 for efficacy and from 0·64 to 0·83 for acceptability. In head-to-head studies, agomelatine, amitriptyline, escitalopram, mirtazapine, paroxetine, venlafaxine, and vortioxetine were more effective than other antidepressants (ORs 1·19–1·96), whereas fluoxetine, fluvoxamine, reboxetine, and trazodone were the least efficacious drugs (0·51–0·84). For acceptability, agomelatine, citalopram, escitalopram, fluoxetine, sertraline, and vortioxetine were more tolerable than other antidepressants (ORs 0·43–0·77), whereas amitriptyline, clomipramine, duloxetine, fluvoxamine, reboxetine, trazodone, and venlafaxine had the highest dropout rates (1·30–2·32). The findings provide the most comprehensive currently available evidence base to guide the initial choice about pharmacological treatment for acute major depressive disorder in adults. Source: http://www.thelancet.com/
