Antidepressants

Comparative efficacy and acceptability of 21 antidepressant drugs for the acute treatment of adults with major depressive disorder: a systematic review and network meta-analysis

Andrea Cipriani, MDCorrespondence information about the author MD Andrea CiprianiEmail the author MD Andrea Cipriani

, 

Prof Toshi A Furukawa, MD†

, 

Georgia Salanti, PhD†

, 

Anna Chaimani, PhD

, 

Lauren Z Atkinson, MSc

, 

Yusuke Ogawa, MD

, 

Prof Stefan Leucht, MD

, 

Henricus G Ruhe, PhD

, 

Erick H Turner, MD

, 

Prof Julian P T Higgins, PhD

, 

Prof Matthias Egger, PhD

, 

Nozomi Takeshima, MD

, 

Yu Hayasaka, MD

, 

Hissei Imai, MD

, 

Kiyomi Shinohara, MD

, 

Aran Tajika, MD

, 

Prof John P A Ioannidis, MD

, 

Prof John R Geddes, MD

†Joint first authors

Published: 21 February 2018

Open Access

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DOI: https://doi.org/10.1016/S0140-6736(17)32802-7

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Open access funded by Department of Health UK

Article Info

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Summary

Background

Major depressive disorder is one of the most common, burdensome, and costly psychiatric disorders worldwide in adults. Pharmacological and non-pharmacological treatments are available; however, because of inadequate resources, antidepressants are used more frequently than psychological interventions. Prescription of these agents should be informed by the best available evidence. Therefore, we aimed to update and expand our previous work to compare and rank antidepressants for the acute treatment of adults with unipolar major depressive disorder.

Methods

We did a systematic review and network meta-analysis. We searched Cochrane Central Register of Controlled Trials, CINAHL, Embase, LILACS database, MEDLINE, MEDLINE In-Process, PsycINFO, the websites of regulatory agencies, and international registers for published and unpublished, double-blind, randomised controlled trials from their inception to Jan 8, 2016. We included placebo-controlled and head-to-head trials of 21 antidepressants used for the acute treatment of adults (≥18 years old and of both sexes) with major depressive disorder diagnosed according to standard operationalised criteria. We excluded quasi-randomised trials and trials that were incomplete or included 20% or more of participants with bipolar disorder, psychotic depression, or treatment-resistant depression; or patients with a serious concomitant medical illness. We extracted data following a predefined hierarchy. In network meta-analysis, we used group-level data. We assessed the studies' risk of bias in accordance to the Cochrane Handbook for Systematic Reviews of Interventions, and certainty of evidence using the Grading of Recommendations Assessment, Development and Evaluation framework. Primary outcomes were efficacy (response rate) and acceptability (treatment discontinuations due to any cause). We estimated summary odds ratios (ORs) using pairwise and network meta-analysis with random effects. This study is registered with PROSPERO, number CRD42012002291.