The most famous antidepressant Prozac, also known by its generic name fluoxetine, was found the least effective of antidepressants in a study that compared the efficacy of 21 antidepressant drugs prescribed for individuals with major depressive disorder.
Antidepressants Are No Snake Oil
Depression affects about 350 million people worldwide and the number of cases increased by nearly 20 percent from 2005 to 2015.
In a new study, researchers sought to evaluate the efficacy of a common form of depression treatment: antidepressants.
Study researcher Andrea Cipriani, from the University of Oxford in the UK, and colleagues looked at data from more than 500 randomized controlled trials, which involved 116,477 individuals and found that all the 21 antidepressants were more effective than placebo.
The researchers nonetheless found that while all the drugs in their study are more effective than placebo at treating depression, some are more effective than the others.
Cipriani and colleagues found that the most effective of these drugs were agomelatine, which is sold under several brand names such as Melitor, Valdoxan, and Thymanax; mirtazapine (Remeron), amitriptyline (Elavil), escitalopram (Lexapro), paroxetine (Paxil), vortioxetine (Trintellix), and venlafaxine (Effexor XR).
The least effective of these drugs were fluoxetine (Prozac), trazodone (Desyrel), fluvoxamine (Faverin), and reboxetine (Edronax).
Prozac may be among the least effective but researchers found that it was also one of the best tolerated of the antidepressants, based on low drop-out rate in clinical trials, and on the reported side effects of using the medications. The most effective of the drugs, amitriptyline, was the sixth best tolerated.
Best Antidepressant Drugs Based On Efficacy And Tolerability
The drugs that scored best for both efficacy and tolerability were agomelatine, escitalopram, and vortioxetine. Those that scored poorly for efficacy and tolerability were fluvoxamine, reboxetine, and trazodone.
The researchers said that their study offers valuable information that can help doctors when prescribing antidepressants to their patients
"In routine practice, clinicians have a wide choice of individual drugs and they need good evidence to make the best choice for each individual patient," the researchers wrote in their study published in the journal The Lancet on Feb. 21.
"Network meta-analyses of existing datasets make it possible to estimate comparative efficacy, summarise and interpret the wider picture of the evidence base, and to understand the relative merits of the multiple interventions."
Not A Perfect Treatment
A large number of people do not respond to antidepressants. They also come with risk. An earlier study found that teens prescribed with high doses of antidepressants tend to be suicidal.
Another study also found a link between language disorders in children and their mothers using antidepressant during pregnancy.