Should antidepressants be used for major depressive disorder?

Publication

BMJ

Author(s)

Janus Christian Jakobsen, Christian Gluud, Irving Kirsch

Abstract

Background
Major depressive disorder is estimated by the WHO to affect more than 300million people globally, making depression the leading cause of disability worldwide. Antidepressants are commonly used to treat depression.

Objective
The study aimed to provide an update on the evidence on the effects of antidepressants compared with placebo. Should antidepressants be used for adults with major depressive disorder? Study selection We searched the Cochrane Library, BMJ Best Practice and PubMed up to June 2019 with the search terms ‘depression’ and ‘antidepressants’ targeting reviews published in English since 1990.

Findings
Several reviews have assessed the effects of antidepressants compared with placebo for depression. Generally, all the previous reviews show that antidepressants seem to have statistically significant effects on depressive symptoms, but the size of the effect has questionable importance to most patients. Antidepressants seem to have minimal beneficial effects on depressive symptoms and increase the risk of both serious and non- serious adverse events.

Conclusions
The benefits of antidepressants seem to be minimal and possibly without any importance to the average patient with major depressive disorder. Antidepressants should not be used for adults with major depressive disorder before valid evidence has shown that the potential beneficial effects outweigh the harmful effects.

Date

September 25, 2019

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