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Making the best use of available evidence: the case of new generation antidepressants
  1. Corrado Barbui1,
  2. Andrea Cipriani1,
  3. Toshiaki A Furukawa2,
  4. Georgia Salanti3,
  5. Julian P T Higgins4,
  6. Rachel Churchill5,
  7. Norio Watanabe2,
  8. Atsuo Nakagawa6,
  9. Ichiro M Omori7,
  10. John R Geddes8
  1. 1 Department of Medicine and Public Health, Section of Psychiatry and Clinical Psychology, University of Verona, Italy
  2. 2 Department of Psychiatry and Cognitive–Behavioural Medicine, Nagoya City University Graduate School of Medical Sciences, Nagoya, Japan
  3. 3 Department of Hygiene and Epidemiology, University of Ioannina School of Medicine, Greece
  4. 4 MRC Biostatistics Unit Institute of Public Health, University of Cambridge, Cambridge, UK
  5. 5 Department of Community Based Medicine and Cochrane Depression, Anxiety and Neurosis Review Group, University of Bristol, Bristol, UK
  6. 6 Department of Neuropsychiatry, School of Medicine, Keio University, Tokyo, Japan
  7. 7 Cochrane Schizophrenia Group, University of Nottingham, Nottingham, UK
  8. 8 Department of Psychiatry, University of Oxford, Oxford, UK
  1. Correspondence to Corrado Barbui, Department of Medicine and Public Health, Section of Psychiatry and Clinical Psychology, University of Verona, Policlinico “GB Rossi”, Piazzale LA Scuro, 10-37134 Verona, Italy; corrado.barbui{at}

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In this issue of Evidence-Based Mental Health, Gartlehner and Gaynes1 comment (see page 98) on our recently published systematic review2 that investigated the comparative efficacy and acceptability of 12 new generation antidepressants (see page 107). In their view, methodological shortcomings limit the validity of our results and the conclusions reached. In this commentary, our aim is to explain the rationale for doing this systematic review, outline its main findings and address the points raised by Gartlehner and Gaynes.1 Scientific debate can illuminate and clarify complex analyses and we are, therefore, delighted to respond to their critique. While we consider that some of the issues raised are substantive and merit reasoned response, we also believe that some of their criticisms seem rather overstated. We understand that Gartlehner and Gaynes too have published an analysis comparing antidepressants and we note that this is now the third occasion on which they have published similar criticisms of our work.3 ,4

The necessity for doing a multiple treatments meta-analysis on new generation antidepressants

In most countries, demonstration of a difference against placebo, and not against an active comparator, makes a new drug eligible for registration. The European Medicines Agency, for example, is willing to evaluate new antidepressants in the absence of comparison with active existing treatments.5 In situations where no (or a few) active treatments are available, this may not be important. In the field of antidepressants, however, where many potentially effective agents are already available, this process has serious implications. The approval of a new antidepressant as effective and safe in comparison solely with placebo allows the marketing of new drugs that may, in fact, be potentially more effective, similarly effective or even less effective than others currently in use. Many antidepressants have never been directly compared with each other. The picture is further complicated by …

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