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post Sep 14, 2010, 06:17 PM
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Studies and information on clinical forms of depression.
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post Sep 21, 2010, 12:35 AM
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The Lancet, Volume 373, Issue 9665, Pages 746 - 758, 28 February 2009
Published Online: 29 January 2009

Editors' note: Depression is a major cause of disability worldwide, and the need for treatment options, whether they be antidepressant drugs or psychological interventions, is correspondingly great. A range of clinically-proven antidepressants is available, and this multiple treatments meta-analysis seeks to draw conclusions from the many randomised trials in which drugs have been studied against active comparators. Weighing systematically the evidence available on both efficacy and tolerability, the authors suggest that sertraline and escitalopram might be appropriate first-choice treatments.

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

Dr Andrea Cipriani PhD a d , Toshiaki A Furukawa MD b, Georgia Salanti PhD c, John R Geddes MD d, Julian PT Higgins PhD e, Rachel Churchill PhD g, Norio Watanabe PhD b, Atsuo Nakagawa MD h, Ichiro M Omori PhD b, Hugh McGuire MA f, Michele Tansella MD a, Corrado Barbui MD a

Summary

Background
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.

Methods
We systematically reviewed 117 randomised controlled trials (25928 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.

Findings
Mirtazapine, escitalopram, venlafaxine, and sertraline were significantly more efficacious than duloxetine (odds ratios [OR] 139, 133, 130 and 127, respectively), fluoxetine (137, 132, 128, and 125, respectively), fluvoxamine (141, 135, 130, and 127, respectively), paroxetine (135, 130, 127, and 122, respectively), and reboxetine (203, 195, 189, and 185, 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

Interpretation
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.

Funding
None.
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nctu127
post Apr 18, 2017, 01:22 AM
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Thank you for your input.
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