Newer depression drugs ‘all equal’
There are no clinically relevant differences in efficacy among the second-generation antidepressants for the management of major depressive disorder (MDD) in adults, a meta-analysis as found.
Individual drugs differed in onset of action, adverse events, and some quality-of-life measures, but "current evidence does not warrant recommending a particular second-generation antidepressant on the basis of differences in efficacy," write Dr Gerald Gartlehner (Danube University, Krems, Austria) and co-authors in the Annals of Internal Medicine.
Dr Gartlehner's team searched the literature for reports of randomized controlled trials and observational studies that assessed benefits and harms of second-generation antidepressants for treating MDD in adults. They found 234 relevant studies, of which 118 were head-to-head randomized controlled trials. Study drugs included citalopram, venlafaxine, escitalopram, fluoxetine, fluvoxamine, paroxetine, bupropion, and sertraline.
Meta-analysis revealed no clinically relevant differences in efficacy or effectiveness for the acute, continuation, and maintenance therapy of MDD. The largest relative differences in response rates were between escitalopram and citalopram and fluoxetine and venlafaxine, but absolute differences were modest, say the researchers.
Furthermore there were no differences in efficacy in patients with accompanying symptoms (such as anxiety and insomnia) or subgroups based on age, gender, ethnicity, or comorbidity. However, there were some differences in onset of action, dosing regimens, and adverse effects. For instance, sexual dysfunction was least likely with bupropion while mirtazepine had the fastest onset of action.
Dr Gartlehner et al conclude: "Possible side effects, convenience of dosing regimens, and costs may best guide the choice of a second-generation antidepressant for treating major depression in adults, because these agents probably have similar efficacy."
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By Joanna Lyford