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The analysis of more than 500 trials did find that some medications worked better than others, however.

The study of 116,477 people concluded that 21 common antidepressants reduced symptoms of acute depression in adults more than placebo pills. Some had small impacts, while others were moderate, depending on the drug.

"Untreated depression is a huge problem because of the burden to society", said Andrea Cipriani of the NIHR Oxford Health Biomedical Research Centre, who led the study.

"Our study brings together the best available evidence to inform and guide doctors and patients in their treatment decisions". Most of the patients had moderate to severe depression. "Our findings are relevant for adults experiencing a first or second episode of depression - the typical population seen in general practice". "If it was cancer and only one in six were getting access to effective treatment we'd think there was something squiffy going on".

Agomelatine, citalopram, escitalopram, fluoxetine, sertraline, and vortioxetine were more tolerable than other antidepressants, whereas amitriptyline, clomipramine, duloxetine, fluvoxamine, reboxetine, trazodone, and venlafaxine had the highest dropout rates, they found.

In the global study published in the Lancet, authors found that fluoxetine-commonly sold under then trade name Prozac-was one of the least effective antidepressants. "Nevertheless, for the millions of individuals with depression who are taking antidepressants at present, or will need to take antidepressants in the future, it confirms that these drugs are safe and effective". Something that may work for one person may have a completely different reaction for someone else.

"I'm not saying all patients with depression should be treated with antidepressants-they should all be offered effective treatments".

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There are a number of treatment and management options available for those affected by depression.

Prof Carmine Pariante, Institute of Psychiatry, Psychology and Neuroscience and spokesperson for the Royal College of Psychiatrists, said the study "finally puts to bed the controversy on antidepressants, clearly showing that these drugs do work in lifting mood and helping most people with depression".

"Anti-depressants are routinely used worldwide yet there remains considerable debate about their effectiveness and tolerability", he said in a statement. Considering all trials, the between-antidepressant differences in odds ratios varied from 1.15 to 1.55 for efficacy and from 0.64 to 0.83 for acceptability.

"The large amount of data allowed more conclusive inferences and gave the opportunity also to explore potential biases".

"Eighty per cent of people stop anti-depressants within a month", he said, when effects normally took at least two months, he said.

There were 64.7 million prescriptions for the drugs in England in 2016 - more than double the 31 million in 2006 - but there has been a debate about how effective they are, with some trial suggesting they are no better than placebos. 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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