Article

Comparative efficacy and acceptability of 12 new-generation antidepressants: A multiple treatments meta-analysis

Department of Medicine and Public Health, Section of Psychiatry and Clinical Psychology, University of Verona, Italy
The Lancet (Impact Factor: 45.22). 02/2009; 373(9665):746-58. DOI: 10.1016/S0140-6736(09)60046-5
Source: PubMed

ABSTRACT

Conventional meta-analyses have shown inconsistent results for efficacy of second-generation antidepressants. We therefore did a multiple-treatments meta-analysis, which accounts for both direct and indirect comparisons, to assess the effects of 12 new-generation antidepressants on major depression.
We systematically reviewed 117 randomised controlled trials (25 928 participants) from 1991 up to Nov 30, 2007, which compared any of the following antidepressants at therapeutic dose range for the acute treatment of unipolar major depression in adults: bupropion, citalopram, duloxetine, escitalopram, fluoxetine, fluvoxamine, milnacipran, mirtazapine, paroxetine, reboxetine, sertraline, and venlafaxine. The main outcomes were the proportion of patients who responded to or dropped out of the allocated treatment. Analysis was done on an intention-to-treat basis.
Mirtazapine, escitalopram, venlafaxine, and sertraline were significantly more efficacious than duloxetine (odds ratios [OR] 1.39, 1.33, 1.30 and 1.27, respectively), fluoxetine (1.37, 1.32, 1.28, and 1.25, respectively), fluvoxamine (1.41, 1.35, 1.30, and 1.27, respectively), paroxetine (1.35, 1.30, 1.27, and 1.22, respectively), and reboxetine (2.03, 1.95, 1.89, and 1.85, respectively). Reboxetine was significantly less efficacious than all the other antidepressants tested. Escitalopram and sertraline showed the best profile of acceptability, leading to significantly fewer discontinuations than did duloxetine, fluvoxamine, paroxetine, reboxetine, and venlafaxine.
Clinically important differences exist between commonly prescribed antidepressants for both efficacy and acceptability in favour of escitalopram and sertraline. Sertraline might be the best choice when starting treatment for moderate to severe major depression in adults because it has the most favourable balance between benefits, acceptability, and acquisition cost.

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    • "For adults, there is a large and diverse group of effective medications available for the treatment of depression (Gartlehner et al. 2011;Hirschfeld 2012), although the selective serotonin reuptake inhibitors (SSRIs) have become predominate over the last few decades (Pratt et al. 2011). The popularity of SSRIs stems from their safety and side-effect profiles, as well as their effectiveness at reducing symptoms of depression and anxiety (Cipriani et al. 2009). In contrast to the multiple pharmacotherapies available for adult populations, only fluoxetine, an SSRI, has proven effective at treating depression in children and adolescents (Mann et al. 2006;Lovrin 2009;Masi et al. 2010;Hetrick et al. 2012). "
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    • "A planar representation by definition is only possible for graph-theoretically planar graphs, such as stars. It is, for example, not possible for the Cipriani antidepressants data in Figure 1 (Cipriani et al., 2009), but it is possible more often than the frequent use of circular representations might suggest. In chemistry, a planar representation, for G. RÜCKER AND G. SCHWARZER example, of the molecule in Figure 2, a hydrocarbon called cubane, is called a Schlegel diagram (Pisanski et al., 1995; Babic & Trinajstic, 2001). "
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    • "As outlined in previous studies, acceptability may encompass efficacy and tolerability outcomes (Cipriani et al., 2009, 2011). In our analysis, under the reviewed atypical antipsychotics only quetiapine (mean dosage: 250–350 mg daily) had significantly more all-cause discontinuations than placebo. "
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