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Antidepressants are widely used for depression based on robust evidence from clinical trials. These studies, however, often exclude people with concurrent illness and medication use, which may limit the generalisability and transportability of their findings to clinical practice – a phenomenon known as the ‘efficacy-effectiveness gap’.
The research study, published in the British Journal of Psychiatry, therefore aimed to fill this gap by assessing the real-world comparative effects between different antidepressants, and then compare that data with those from randomised controlled trials.
The authors used QResearch primary care electronic health records to include a large “real-world” sample of 673,177 people with first-episode depression, including patients with several comorbidities and concomitant medications.
The study showed that antidepressants as used in the real-world have overall low acceptability, moderate-to-high tolerability and safety, and small-to-moderate effectiveness. SSRIs (Selective Serotonin Reuptake Inhibitors such as citalopram, fluoxetine, and sertraline) display the most favourable benefit/risk profile. These observational findings were broadly in line and complement those from randomised controlled trials.
Dr Riccardo De Giorgi, study co-first author and Clinical Lecturer in General Adult Psychiatry at the University of Oxford, said:
This real-world study is a useful complement to evidence we have from randomised controlled trials. It confirms that antidepressants medications are useful against depression, but more work needs to be done along with patients to improve treatment acceptability and effectiveness.”
Dr Franco De Crescenzo, study co-first author and previously a researcher at the University of Oxford (now Clinical Programme Leader at Boehringer Ingelheim), said:
"This study bridges the gap between clinical trials and the complexity of real-world data, providing valuable insights into the risk benefit of antidepressants in diverse patient populations.”