Are all antidepressants equal?

Evidence based data to answer this question and to guide selection of treatments has been limited. Because of the lack of available direct head to head comparisons, prior systematic reviews have been able to say little about differences among the medications. 4 5 The ideal studies to fill this knowledge gap would be large, pragmatic, randomised controlled trials (RCTs) that directly compare the benefits and harms of SGAs. The primary outcomes were response (defined as a 50% improvement of the baseline score) and treatment discontinuation rates at 8 weeks. Because not all antidepressants have been compared directly in RCTs, Cipriani and colleagues 3 used a statistical technique called multiple treatments meta-analysis to derive estimates of the comparative efficacy and safety for all possible comparisons among SGAs.