Select antidepressants show balance in efficacy, acceptability in adults with MDD

Antidepressants desvenlafaxine, paroxetine, venlafaxine and vortioxetine were found to have reasonable acceptability, efficacy and tolerability in the treatment of adults with stable major depressive disorder.

“To the best of our knowledge, this is the first systematic review and network meta-analysis to investigate which antidepressant has the best balance of efficacy and acceptability for the treatment of adult individuals with MDD in the maintenance phase,” Taro Kishi, MD, PhD, and colleagues said in the study.

The primary outcome was the 6-month relapse rate, or efficacy, and the secondary outcome was all-cause discontinuation, or acceptability. Other outcomes included tolerability, or discontinuation due to adverse events, and safety, or the incidence of individual adverse events.

After a literature search, the researchers ended up including 34 double-blind, randomized placebo-controlled trials involving 9,384 patients with MDD (mean age, 43.80 years; 68.10% women). The average length of the studies was 40.94 ± 16.27 weeks. During the open-label study, patients were stabilized on the antidepressant of choice and then randomized to receive either a placebo or the same antidepressant.

Amitriptyline, citalopram, desvenlafaxine, duloxetine, fluoxetine, fluvoxamine, mirtazapine, nefazodone, paroxetine, reboxetine, sertraline, tianeptine, venlafaxine and vortioxetine outperformed placebo in terms of the 6-month relapse rate. Desvenlafaxine, paroxetine, sertraline, venlafaxine, and vortioxetine had lower all-cause discontinuation compared to the placebo; sertraline had a higher discontinuation rate due to adverse events. Desvenlafaxine, sertraline and vortioxetine were associated with a higher incidence of nausea, while venlafaxine was associated with a lower incidence of dizziness.

“The efficacy, acceptability, tolerability and safety of the treatment of MDD in the maintenance phase should be carefully considered as treatments prescribed for an acute depressive episode are typically continued into maintenance. Results of a network meta-analysis of adults with acute MDD also revealed that desvenlafaxine, paroxetine, venlafaxine and vortioxetine had good efficacy and acceptability,” Kishi and colleagues said in the study.