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Review: clinically important differences between antidepressants

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What are the effects of the 12 most commonly prescribed new generation antidepressants for moderate to severe major depression in adults?


Response to treatment at 8 weeks, defined as the proportion of patients having a 50% or greater reduction from baseline in Hamilton Depression Rating Scale or Montgomery–Asberg depression rating scale or those scoring “much improved” or “very much improved” on the clinical global impression; discontinuation as a measure of acceptability of treatment defined as the number of patients who terminated the study early for any reason during the first 8 weeks of treatment.



Systematic review with meta-analysis (pairwise with random effects model and mixed treatment meta-analysis).

Data sources:

Cochrane Collaboration Depression, Anxiety and Neurosis Controlled Trials registers (searched November 2007).

Study selection and analysis:

Randomised controlled trials comparing any of the following new generation antidepressants being used as monotherapy to treat adults with unipolar major depression: duloxetine, velanfaxine, sertraline, bupropion, citalopram, escitalopram, fluoxetine, minacipran, fluvoxamine, mirtazapine, paroxetine and reboxetine were included. Two independent reviewers evaluated the methodological quality of the trials and extracted the data. Responders to treatment were calculated on a conservative intention …

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  • Sources of funding Unclear.


  • Competing interests: RHM-W has received support from a number of pharmaceutical companies who manufacture antidepressants, including Eli Lilly, GlaxoSmithKline, Lundbeck, Organon, Pfizer, Servier and Wyeth.

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