Meta-analysis of first- and second- generation antidepressants

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Important insights into differences in efficacy

While antidepressants are used worldwide to treat major depressive disorder, there is still a debate among the scientific literature regarding their effectiveness and potential differences. Doctors and clinicians are confronted with a range of drug choices, and require sound evidence to design the best treatment for their patients.

To better inform practice and mental health policies, Professor Toshi A Furukawa and colleagues conducted a network meta-analysis of trial data from 1979 and 2016. Their findings were published in the journal, The Lancet .

The analysis involved 21 commonly used antidepressants, examined in 522 double-blind randomized controlled trials. The final results represented data from 116,477 participants.

The researchers found that of the 21 commonly used antidepressants for major depression among adults, all were found to be more efficacious than the placebo. However, there were small but important differences among them in terms of efficacy and acceptability. While certain drugs showed comparatively favorable balance in terms of overall response and dropout rate, others were less so.

Interestingly, the data from adults differed between children and adolescents. The team state that this contrast in efficacy across age groups may reflect the heterogeneous mechanisms and causes of depression.

Furukawa hopes that this extensive study will improve overall mental healthcare for patients suffering from major depression. Even though differences between common antidepressants are small, they are clinically significant enough that patients and physicians need to be informed to make the proper choices in their treatments.

Network of eligible comparisons for acceptability (Kyoto University / Furukawa Lab)

Paper information



Andrea Cipriani, Toshi A Furukawa, Georgia Salanti, Anna Chaimani, Lauren Z Atkinson, Yusuke Ogawa, Stefan Leucht, Henricus G Ruhe, Erick H Turner, Julian P T Higgins, Matthias Egger, Nozomi Takeshima, Yu Hayasaka, Hissei Imai, Kiyomi Shinohara, Aran Tajika, John P A Ioannidis, John R Geddes (2018). 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 Lancet.