Intended for healthcare professionals


Choosing a second generation antidepressant for treatment of major depressive disorder

BMJ 2012; 344 doi: (Published 14 February 2012) Cite this as: BMJ 2012;344:e1014
  1. Helen Lester, professor of primary care1,
  2. Simon Gilbody, professor of psychological medicine and health services research2
  1. 1University of Birmingham, Birmingham B15 2TT, UK
  2. 2University of York and HYMS, York, UK
  1. h.e.lester{at}

Involve patients in decision because drugs have similar efficacy but side effect profiles differ

Depression is a major cause of disability worldwide,1 with costs and consequences at the level of the individual, the family, and society.2 Effective treatments—both drug based and psychological—are much needed. A variety of antidepressants have been shown to be effective in clinical trials, and primary care and secondary care clinicians seem to have almost too much choice. However, recent meta-analyses of the comparative efficacy and safety of second generation antidepressants have reached conflicting conclusions, muddying the therapeutic waters. The most recent meta-analysis found little difference in efficacy among second generation antidepressants,3 whereas an earlier one found that escitalopram and sertraline had the best efficacy to acceptability ratio.4 National Institute for Health and Clinical Excellence guidance in England and Wales suggests that the first choice antidepressant should be a generic selective serotonin reuptake inhibitor (SSRI).5

The most recent meta-analysis reviewed 234 studies (including 118 head to head drug trials) published between 1980 and August 2011 and focused on the benefits and harms of 13 pharmacologically different second generation antidepressants for treating major depressive disorder.[3] Their method included inviting …

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