All antidepressants are created equal

When it comes to choosing an antidepressant, all modern drugs are roughly equivalent, according to a new study in the Annals of Internal Medicine. Researchers performed a large meta-analysis of 234 studies that looked at the treatment of major depressive disorder (MDD) with second-generation antidepressants. There were no differences among the drugs with regard to efficacy or effectiveness for the treatment of acute, continuation, and maintenance phases of MDD. There were also no significant differences when accompanying symptoms were taken into account or other factors such as age, sex, ethnicity, or comorbid conditions. There were differences among the drugs with regard to onset of action, adverse effects, and some quality-of-life issues. There was also a significant difference in cost and dosing convenience. Drugs considered in the study were bupropion, citalopram, desvenlafaxine, duloxetine, escitalopram, fluoxetine, fluvoxamine, mirtazapine, nefazodone, paroxetine, sertraline, trazodone, and venlafaxine. The authors suggest that familiarity with the broad spectrum of antidepressants is prudent given the difficulty of predicting which medication will be effective and tolerated by any given patient (Ann Intern Med 2011;155:772-785).