This study included 522 clinical trials in which a total of about 116,000 persons with major depressive disorder participated.
All studies considered
It found that all 21 antidepressants studied were more effective than placebo.
Before reviewing the main findings regarding discontinuation of treatment, let’s remember that the rates for discontinuation of treatment are affected by many factors including adverse events and lack of efficacy. Here are the three main findings regarding discontinuation:
1. For almost all antidepressants, the rates of discontinuation were not statistically significantly different from placebo.
2. Only two antidepressants (agomelatine and fluoxetine) were associated with a statistically significantly lower discontinuation rate than placebo.
3. Only one antidepressant—clomipramine—was associated with a statistically significantly greater discontinuation rate than placebo.
Only head-to-head studies considered
The paper reported that when only head-to-head studies were considered, “agomelatine, amitriptyline, escitalopram, mirtazapine, paroxetine, venlafaxine, and vortioxetine were more effective than other antidepressants.”
It also reported that, “fluoxetine, fluvoxamine, reboxetine, and trazodone were the least efficacious drugs.”
For discontinuation rates, it reported that agomelatine, citalopram, escitalopram,
fluoxetine, sertraline, and vortioxetine had lower rates of discontinuation than other antidepressants.
And, that amitriptyline, clomipramine, duloxetine, fluvoxamine, reboxetine, trazodone, and venlafaxine had the highest rates of discontinuation.