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- Page navigation anchor for Antidepressants can benefit patients with major depression, and a 10th key issue is which drugs should be used first-lineAntidepressants can benefit patients with major depression, and a 10th key issue is which drugs should be used first-line
We agree with Arroll and colleagues1 that GPs should think carefully before prescribing antidepressants, but they suggested even patients with severe depression are unlikely to benefit, citing a 2010 study2 and ignoring the recent Lancet meta-analysis comparing 21 antidepressants and showing that all were more efficacious than placebo for major depression.3
We understand concerns about increasing GP antidepressant prescribing, and worry the widely reported meta-analysis might increase overall prescribing, rather than influence the relative use of different antidepressants, which was its aim.3 However, we have data to suggest its impact will not be to increase prescribing for new episodes.
We explored the effects of a 2009 meta-analysis by the same group, comparing 12 antidepressants,4 on GP prescribing using Clinical Practice Research Datalink data. The previous study stated that sertraline, having the most favourable balance between benefits, acceptability, and cost, might be the best initial choice.4 To explore the effects of this, we conducted time trend analyses of percentages of GP prescriptions for different antidepressants, modelled as an interrupted time series.
The figure shows percentages of antidepressants prescribed first-choice, for first-ever and recurrent episodes of depression, for citalopram, fluoxetine, sertraline, mirtazapine, and escitalopram. Time trend anal...
Show MoreCompeting Interests: None declared.