For a long time there has been debate and concern as to how effective and safe antidepressants really are; however, a new review of clinical studies has provided convincing data that if given sufficient time, antidepressants do work, and the benefits can outweigh the potential for side effects.
The review of clinical studies shows that antidepressants are effective, but must be given a chance to work.
The review was published in the Lancet, a medical journal. In one of the most comprehensive reviews of published and unpublished data to date, researchers reviewed 522 trials of 21 different antidepressants, including 116 477 adults with depression who were treated for around 8 weeks.
They defined efficacy as 50% or greater reduction in symptoms and also looked at remission, a measure of complete resolution of symptoms.
Discontinuation of treatment and patient acceptability were compared as an indicator of how well the treatments were tolerated over time.
All of the antidepressant types were more effective over time than placebo, but some were more effective, better tolerated and more acceptable to patients than others.
One of these was agomelatine. It was among the most effective, but stood out because it was also associated with a very low potential for side effects. In terms of study drop-outs, agomelatine was one of only two antidepressants that was actually better tolerated than placebo.
Agomelatine is an unusual antidepressant, because, in addition to an effect on some of the more traditional chemical pathways in the brain (e.g. serotonin and dopamine), it is the only one that works by affecting the same areas of the brain as melatonin - the hormone associated with normal sleep.
However, unlike the majority of other commonly used antidepressants, it does not directly increase serotonin. This mechanism of action may account for not only its effectiveness in treating the symptoms of depression and low tendency to cause side effects or withdrawal symptoms, but also its tendency to improve anxiety and quality of sleep.
Sleep is often adversely affected in people with depression. In contrast, agomelatine is unlikely to cause sedation and, unlike many other antidepressants, it is not associated with sexual problems or weight gain.
In a statement, Servier International Pharmaceutical Group said this large, well designed and thorough review of antidepressants is encouraging and provides reassurance that, if they seek help from their doctor or local clinic, effective treatment is available for people with depression.
“However, it is important to remember that once an appropriate medication has been started, it is necessary to stay on it in order to give it a chance to work,” they said.
According to the South African Depression and Anxiety Group (SADAG) as many as 1 in 5 South Africans may experience a severe episode of depression at least once in their lifetime and women are twice as likely to suffer from depression than men.
According to the World Health Organisation, globally fewer than half of those affected by depression ever receive treatment. SADAG estimates that only around 1 in 6 people with any mental illness receive treatment.