Comparative efficacy and acceptability of 12 new-generation antidepressants: a multiple-treatments meta-analysis.
This meta-analysis found clinically significant differences between 12 new-generation antidepressants. Escitalopram and sertraline were among the most efficacious and most tolerable. Mirtazapine and venlafaxine were also among the most efficacious, but not as tolerable. Reboxetine was least efficacious and least tolerable.
- Reviewed 117 randomized controlled trials (n=25,928) which compared antidepressants to treat major depressive disorder in adults. Many studies comparing newer antidepressants (mirtazapine, escitalopram, buproprion, and duloxetine) were performed by pharmaceutical companies, and the authors acknowledge that this may be a source of bias.
- Antidepressants included in analysis: buproprion, citalopram, duloxetine, escitalopram, fluoxetine, fluvoxamine, milnacipran, mirtazapine, paroxetine, reboxetine, sertraline, venlafaxine.
- Primary outcomes: response rates and dropout rates.
- Mirtazapine, escitalopram, venlafaxine, and sertraline were significantly more efficacious than duloxetine, fluoxetine, fluvoxamine, paroxetine, and reboxetine.
- Escitalopram and sertraline were the most acceptable, with significantly lower discontinuation rate than duloxetine, fluvoxamine, paroxetine, reboxetine, and venlafaxine.
- Reboxetine was least efficacious (significantly lower than all eleven other antidepressants examined), and was the only antidepressant that was significantly less tolerable than fluoxetine.
Cipriani A, Furukawa TA, Salanti G, et al. Comparative efficacy and acceptability of 12 new-generation antidepressants: a multiple-treatments meta-analysis. Lancet. 2009;373(9665):746–758. doi:10.1016/S0140-6736(09)60046-5.