Antidepressants Rated for Major Depression


Escitalopram and sertraline were the most effective of a dozen second-generation antidepressants for treating major depression in adults, results of a review of randomized controlled trials that included more than 25,000 patients show.

Previous studies of the effectiveness of second-generation antidepressants have been inconsistent, said Dr. Andrea Cipriani of the University of Verona (Italy). Dr. Cipriani and his colleagues reviewed 117 randomized, controlled trials using a multiple-treatment meta-analysis, so they could compare treatments within and between trials.

The average length of treatment was 8 weeks, and the average sample size was 110 patients. The studies included a total of 25,928 adults (65% women) who participated in studies for the treatment of acute unipolar major depression between 1991 and 2007.

The review included the following drugs: bupropion, citalopram, duloxetine, escitalopram, fluoxetine, fluvoxamine, milnacipran, mirtazapine, paroxetine, reboxetine, sertraline, and venlafaxine (Lancet 2009 [doi: 10.1016/S0140-6736(09)60046-5]).

Overall, some of the medications were significantly and clinically different in their effectiveness and acceptability. The four medications that were best tolerated were escitalopram, sertraline, citalopram, and bupropion. But the four drugs that were the most effective were mirtazapine, escitalopram, venlafaxine, and sertraline. Reboxetine was significantly less effective than any of the other 11 medications.

“The results indicate the two of the most efficacious treatments (mirtazapine and venlafaxine) might not be the best for overall acceptability,” they said.

“Our findings might help to choose among new generation antidepressants for acute treatment of major depression,” they noted.

The study results were limited to 8-week acute-phase treatment of depression and did not include a formal cost-effectiveness analysis, but the researchers suggested that sertraline may be the first choice financially in many countries.

Dr. Cipriani had no financial conflicts to disclose.

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