The World Health Organization reports 300 million people live with depression, but less than half receive effective treatment.
A recent study in the journal The Lancet has been making headlines for comparing the effectiveness of antidepressant medications — information that is often lacking for patients trying to make informed choices about their treatments. They found that all of the medications were modestly more effective than a placebo and some were more effective than others. With help from our research team, we took a closer look at what these findings really mean and how they compare to what members are reporting on PatientsLikeMe.
Let’s break down the research
Researchers looked at 474 placebo-controlled and head-to-head trials including a total of 100,000+ paients on their first line of treatment for major depressive disorder. They compared the effectiveness of 21 different antidepressants to each other and a placebo. The medications were randomly assigned.
- Some antidepressants, such as escitalopram (Lexapro), mirtazapine (Remeron), paroxetine (Paxil), agomelatine (Melitor), and sertraline (Zoloft) were more effective with lower dropout rates (patients who stopped taking the medication due to side effects or other factors).
- Medications like Reboxetine (Edronax), trazodone (Desyrel), and fluvoxamine (Fevarin) had lower efficacy.
- The antidepressants with the highest efficacy were amitriptyline (Elavil) and escitalopram (Lexapro), while fluoxetine (Prozac) had the lowest.
- All of the antidepressants were more effective than a placebo in treating MDD, although the effects were modest.
- The majority of the clinical trials included in this study were selective and didn’t include people with more complex situations (like living with another condition in addition to MDD).
- The study didn’t include people with treatment-resistant depression (which could be as many as 30% of people with MDD who have tried two or more medications).
- Researchers only analyzed short-term treatment (8 weeks), so it’s unclear how the antidepressants may work in the long-term.
- The study only looked at treatment effectiveness, not tolerability (when the medication works but a person stops taking it because of the side effects).
- The findings were general and based on average results (across all people in the trials), so there’s little insight on targeting treatments for individuals.
Here are some commonly reported ways PatientsLikeMe members are treating their major depressive disorder (MDD):
- 2,000+ members report taking bupropion (Wellbutrin)
- 63% say that it’s at least moderately effective in treating their MDD
- 1,800+ members report taking duloxetine (Cymbalta)
- 67% say that it’s at least moderately effective in treating their MDD
Venlafaxine (Effexor XR)
- 1,700+ members report taking venlafaxine (Effexor XR)
- 74% say that it’s at least moderately effective in treating their MDD
- 1,500+ members report taking sertraline (Zoloft)
- 55% say that it’s at least moderately effective in treating their MDD
- 1,500+ members report taking fluoxetine (Prozac)
- 61% say that it’s at least moderately effective in treating their MDD
Finding what works for you
Many patients have tried several antidepressants in their search to find what works for them (if you’re a PatientsLikeMe member, you can check out what others have shared about this in a recent study). Some studies also show that medication may be more effective when combined with cognitive behavioral therapy. Talk to your doctor to find the best approach to treatment for you.
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