Patients with moderate-to-severe depression frequently ask me whether they should consider antidepressant drugs or not. I provide my response below, based on the latest psychiatry literature.

The most recent large-scale research comparing antidepressant drugs with placebo was conducted by Cipriani and colleagues at the University of Oxford in 2018. This research was unique because the researchers did not conduct their own independent study, but rather performed an exhaustive search of all high-quality studies of antidepressants (published and unpublished) between 1979 and 2016, and attempted to calculate the overall effect of antidepressants, averaging across studies. In the end, 522 high-quality double-blind studies comparing antidepressants to placebo were chosen for analysis. In total, 116,477 total patients with moderate-to-severe major depressive disorder were included. Depression scores were compared after 8 weeks of acute treatment with either an antidepressant or a placebo. The latest statistical techniques were used to analyze the data.

So what did they find? Citing Cipriani et al. (2018) verbatim:

“We found that all antidepressants included in the meta-analysis were more efficacious than placebo in adults with major depressive disorder.” [1]

When asked by the NHS to summarize the study, lead author Andrea Cipriani had this to say:

“Our study brings together the best available evidence to inform and guide doctors and patients in their treatment decisions. We found that the most commonly used antidepressants are more effective than placebo.” [2]

Simply put, adults with moderate-to-severe depression are more likely to see their symptoms improve after eight weeks if they take an antidepressant than if they don’t. Medication should always be considered carefully on a case-by-case basis, but this largest-ever review of double-blind, placebo-controlled antidepressant trials says that, yes, doctors and patients would be wise to include antidepressants as one of the treatment options for consideration.

References

  1. Cipriani, A., Furukawa, T. A., Salanti, G., Chaimani, A., Atkinson, L. Z., Ogawa, Y., … Geddes, J. R. (2018). 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. Lancet, 391, 1357–1366. doi:http://dx.doi.org/10.1016/S0140-6736(17)32802-7
  2. NHS: Big new study confirms antidepressants work better than placebo