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Four Antidepressants Found to Have Best Efficacy, Acceptability, and Tolerability in Patients With MDD
In a widespread study of 20 common antidepressants, desvenlafaxine, paroxetine, venlafaxine, and vortioxetine were found to have the best efficacy, acceptability, and tolerability in major depressive disorder (MDD) treatment in the maintenance phase, according to a study published in Molecular Psychiatry.
“However, desvenlafaxine and vortioxetine had a risk of nausea/vomiting in adults with MDD in both the maintenance and acute phases,” lead author Taro Kishi, Fujita Health University School of Medicine, Toyoake, Aichi, Japan, and co-authors noted. Still, “the efficacy, acceptability, tolerability, and safety of the treatment of MDD in the maintenance phase should be carefully considered as treatments prescribed for an acute depressive episode are typically continued into maintenance.”
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Researchers pulled 34 previous studies on 20 antidepressants from PubMed, Cochrane Library, and Embase databases. All studies included were double-blind, randomized, placebo-controlled trials with enrichment designs—patients took an antidepressant during the open-label study and were then randomly given the same antidepressant or the placebo.
Measured outcomes included a 6-month relapse rate, all-cause discontinuation, discontinuation due to adverse events (tolerability), and the incidence of individual adverse events. The 20 antidepressants analyzed were: agomelatine, amitriptyline, bupropion, citalopram, desvenlafaxine, duloxetine, escitalopram, fluoxetine, fluvoxamine, levomilnacipran, milnacipran, mirtazapine, nefazodone, paroxetine, reboxetine, sertraline, tianeptine, venlafaxine, vilazodone, and vortioxetine.
Amitriptyline, citalopram, desvenlafaxine, duloxetine, fluoxetine, fluvoxamine, mirtazapine, nefazodone, paroxetine, reboxetine, sertraline, tianeptine, venlafaxine, and vortioxetine all had a better 6-month relapse rate than the placebo. Risk ratios (RR) ranged from 0.149 (for nefazodone) to 0.583 (for fluoxetine). Compared to placebo, desvenlafaxine, paroxetine, sertraline, venlafaxine, and vortioxetine had lower all-cause discontinuation with RRs between 0.523 to 0.768. Sertraline had a higher rate of discontinuation because of adverse events. No antidepressants were associated with increased incidences of headache, insomnia, dry mouth, constipation, sweating, weight gain, or sexual dysfunction.
“To the best of our knowledge, this is the first systematic review and network meta-analysis to investigate which antidepressant has the best balance of efficacy and acceptability for the treatment of adult individuals with MDD in the maintenance phase,” researchers concluded.
