Prof Pariante said this type of study can not account for individual differences in response to medication, and "we still need to understand why some antidepressants work better than others, even within classes of drugs that supposedly have the same pharmacological actions".
In some cases, people are put on increased dosages because they believe their depression isn't getting any better.
"This study is the final answer to a long-standing controversy about whether anti-depressants work for depression", revealed Cipriani, when discussing her study with the BBC.
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Crucially, Kirsch's 2008 meta-analysis showing antidepressants are no more effective than placebo included data sent by pharmaceutical companies to the Food and Drug Administration to approve various antidepressants-which Kirsch obtained through the Freedom of Information Act. Some had small impacts, while others were moderate, depending on the drug.
"Our study brings together the best available evidence to inform and guide doctors and patients in their treatment decisions", said research head, Dr Andrea Cipriani, University of Oxford and the Oxford Health Biomedical Research Centre. The choice will be need to made by doctor and patient'. The number is much worse for people in developing countries, with just one in 27 people seeking treatment. In head-to-head studies, researchers observed that agomelatine, amitriptyline, escitalopram, mirtazapine, paroxetine, venlafaxine and vortioxetine were the most effective antidepressants, whereas fluoxetine, fluvoxamine, reboxetine and trazodone were the least effective. They included clinical trials that compared 21 commonly used antidepressant medications or placebo in their network meta-analysis; overall, 87,052 participants received an antidepressant drug and 29,425 received placebo.
But it also showed big differences in how effective each drug is. Something that may work for one person may have a completely different reaction for someone else.
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'Medication should always be cnsidered alongside other options, such as psychological therapies, where these are available'. Currently, one in six people in the "developed" world receives proper treatment for moderate to severe depression. This is likely in part due to the extremely broad medical definition of "depression"; many people are classified as having the same disorder, even if the underlying biological and social influences causing the illness vary considerably.
Antidepressants are widely prescribed around the world, there has been considerable debate around their effectiveness.
"The large amount of data allowed more conclusive inferences and gave the opportunity also to explore potential biases".
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The most famous antidepressant of them all, Prozac - now out of patent and known by its generic name, fluoxetine - was one of the least effective but best tolerated, measured by a low drop-out rate in the trials or fewer side-effects reported. Moreover, they consulted pharmaceutical companies, original study authors, and regulatory agencies to supplement incomplete reports of the original papers, or provide data for unpublished studies.
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