February 21, 2018

expert reaction to largest review of antidepressants

Scientists have published a systematic review and meta-analysis of antidepressant drugs in The Lancet.

A briefing accompanied this roundup.

Prof Glyn Lewis, Professor of Psychiatric Epidemiology, UCL, said:

“This excellent and comprehensive study pulls together all the evidence for the effectiveness of antidepressant treatment and provides compelling evidence for their efficacy. Antidepressants often receive a ‘bad press’ but this paper shows they have a role in the management for people with depression.”

Prof Carmine Pariante, Institute of Psychiatry, Psychology and Neuroscience and spokesperson for the Royal College of Psychiatrists, said:

“This meta-analysis finally puts to bed the controversy on antidepressants, clearly showing that these drugs do work in lifting mood and helping most people with depression. Importantly, the paper analyses unpublished data held by pharmaceutical companies, and shows that the funding of studies by these companies does not influence the result, thus confirming that the clinical usefulness of these drugs is not affected by pharma-sponsored spin. Of course, these type of studies cannot look at individual differences, so cannot inform us about the specific personal characteristics that make an individual more likely to respond in general, or to respond to one medication rather than another one. Indeed, we still need to understand why some antidepressants work better than others, even within classes of drugs that supposedly have the same pharmacological actions. Also, this paper does not help us understand how best to help patients who have treatment-resistant depression and cannot improve on any of the 21 antidepressants tested here. Nevertheless, for the millions of individuals with depression who are taking antidepressants at present, or will need to take antidepressants in the future, it confirms that these drugs are safe and effective.”

Prof Anthony Cleare, Professor of Psychopharmacology & Affective Disorders, King’s College London and Consultant Psychiatrist, Maudsley Hospital, London, said:

“This is the most up to date summary of all the data we have on how well antidepressants work, and whether people are able to tolerate a full course of treatment without stopping medication early.  Whilst no single study is perfect or able to provide all the answers, putting all the studies together as the authors of this work have done allows us the best chance of seeing the overall big picture.

“It is an important piece of work. It puts to bed the idea that antidepressants don’t work – all 21 antidepressants were more effective than placebo at treating depression.

“It also challenges the often-held view that all antidepressants are more or less equally effective. Several treatments do seem work better than others.

“In terms of tolerability, it is interesting that for almost all antidepressants, patients are no more likely to stop treatment early when taking an antidepressant than when taking a placebo. Some treatments were even better tolerated than placebo.  This suggests that, overall, patients judge that the greater effect of antidepressants in relieving depression counterbalances any side effects.

“The decision to prescribe an antidepressant should always be a joint one between patients and clinicians, individualised to the person’s specific needs. By clarifying which antidepressants are most effective, and which ones patients find easiest to take, this new work will greatly help clinicians and patients in those decisions.”

Prof Allan Young, Director of the Centre for Affective Disorders, King’s College London’s Institute of Psychiatry, Psychology & Neuroscience, said:

“This is good quality research and the conclusions are backed up by solid data.

“However, we should be aware that these findings only apply to major depressive disorder and are calculated from group data so individual patients may differ significantly in their responses.  A range of treatment choices should therefore be maintained. Also a lot of “antidepressants” are used for other disorders (such as anxiety or OCD) or off-label (where the drug is prescribed for something other than the original condition for which it was officially approved) and this evidence does not apply in these instances.

“However, the top line is that these findings should be considered good news as they confirm existing evidence that antidepressants do work and, for most people, the side-effects are worth it.”

Prof David Taylor, Professor of Psychopharmacology, King’s College London, said:

“This analysis of a huge number of studies of antidepressants confirms that they are much more effective than placebo – itself a powerful treatment in depression. Differences between antidepressants are smaller, although newer drugs tend to be better tolerated.  However, the most effective drug was amitriptyline – an antidepressant discovered in the 1950s. Overall this analysis of over 500 published and unpublished studies of antidepressants proves that they do indeed work.”

Dr James Warner, Reader in Psychiatry, Imperial College London, said:

“This rigorous study confirms that antidepressants have an important place in the treatment of depression. Depression causes misery to countless thousands every year and this study adds to the existing evidence that effective treatments are available. This study also adds clarity about how effective and how well tolerated all the common antidepressants are, and should help clinicians and patients in treatment choices.”

* ‘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’ by Cipriani et al. published in The Lancet on Wednesday 21^st February. 

The SMC also produced a Factsheet on antidepressants which is attached and available here: http://www.sciencemediacentre.org/antidepressants/

Declared interests

Prof Glyn Lewis: “I am acting as an expert witness in a case concerning withdrawal effects of paroxetine.”

Prof Carmine Pariante: “I have received research funding from pharmaceutical companies developing novel antidepressants”

Prof Anthony Cleare: “Prof Cleare has in the last three years received honoraria for speaking from Astra Zeneca and Lundbeck, honoraria for consulting from Allergan, Livanova, Lundbeck and Janssen, and research grant support from Lundbeck, the Medical Research Council (UK), Wellcome Trust (UK) and the National Institute for Health Research (UK).  Prof Cleare leads a clinical service treating patients with depression using both pharmacological and non-pharmacological treatments.”

Prof Allan Young: “Employed by King’s College London; Honorary Consultant SLaM (NHS UK); Paid lectures and advisory boards for all major pharmaceutical companies with drugs used in affective and related disorders; No share holdings in pharmaceutical companies; Lead Investigator for Embolden Study (AZ), BCI Neuroplasticity study, CN210 GAD and Aripiprazole Mania Study; Investigator initiated studies from AZ, Eli Lilly, Lundbeck, Wyeth; Grant funding (past and present): NIHR-BRC (UK); NIMH (USA); CIHR (Canada); NARSAD (USA); Stanley Medical Research Institute (USA); MRC (UK); Wellcome Trust (UK); Royal College of Physicians (Edin); BMA (UK); UBC-VGH Foundation (Canada); WEDC (Canada); CCS Depression Research Fund (Canada); MSFHR (Canada); NIHR (UK); Has acted as an expert witness on clinical psychopharmacology in various cases.”

Prof David Taylor: “I am employed by the NHS, King’s College London, Mental Health Research Network, Department for Transport and Driver and Vehicle Licensing Agency (DVLA). I am an Advisory Board member for Lundbeck, Servier and Sunovion. I receive research funding from Bristol-Myers Squibb, Janssen and Lundbeck. I have given lectures for Janssen, Otsuka, Servier and Lundbeck.  Of these companies, Lundbeck market several SSRIs and Servier market an antidepressant with a different mode of action.”

Dr James Warner: “No conflicts of interest”