A Comparative Efficacy of Antidepressants in the Treatment of Major Depressive Disorder: A Systematic Review and Meta-Analysis

Abstract

Major Depressive Disorder (MDD) affects about 280, 000, 000 people globally, with a higher incidence among females than males. The increasing incidence implicates health burdens and clinical dilemmas regarding the low efficacy of the existing antidepressants. A literature search was performed on electronic databases, PubMed, the Cochrane Library of Randomized Trials, Scopus, and ProQuest, for studies reporting the efficacy of an SNRI (Desvenlafaxine 50 mg/d), a serotonin modulator (Vortioxetine 10-20 mg/d), and an aminoketone antidepressant (Bupropion). Study selection focused on randomized controlled trials (RCTs) and observational studies. All statistical analyses and visualization were performed using the Review Manager (RevMan) software and Python programming. The random effects model, ANOVA test, and Cohen’s d were used for statistical analyses. The present meta-analysis involved 17 studies, including 11, 533 participants. The results aligned with previous studies and accounts provided by literature regarding the efficacy of antidepressants used to manage MDD. Five studies, including 2, 377 MDD patients, reported a statistically significant outcome, that Desvenlafaxine 50 mg/d reduced MDD’s severity than placebo (OR: 0.52, 95% CI [0.44, 0.62], P < 0.00001, I2 = 0%). Three studies involving 742 MDD patients reported the efficacy of dextromethorphan-bupropion (AXS-50). The reduction of MADRS scores in the treatment group was statistically insignificant, with high variability, favouring the placebo (OR of 1.85 [95% CI: 0.93, 3.70], p = 0.08, I2 = 79%). Additionally, Vortioxetine 10-20 mg/d produced adverse effects, headache, vomiting, nausea, diarrhea, dizziness, nasopharyngitis, somnolence, and suicidal ideation among 6, 669 MDD patients reported by the 9 studies. The finding was statistically significant but with a high variability OR: 15.25, 95% CI [12.55, 18.52], P < 0.00001, I2 = 98%). A preliminary analysis of evidence collected following Desvenlafaxine, AXS-50, and Vortioxetine administration yielded compelling evidence on the efficacy of antidepressants in MDD treatment. Desvenlafaxine and AXS-50 reported reduced severity and symptomatology in MDD, respectively. On the other hand, Vortioxetine implicated adverse effects, which are common with most antidepressants. Despite adverse effects like headache, vomiting, nausea, diarrhea, dizziness, nasopharyngitis, somnolence, and suicidal ideation, antidepressants used to treat MDD yield clinically satisfying outcomes like decreased severity of depression and relief from symptoms. Clinicians should monitor patients to take care of any adverse effects resulting from the treatments. Keywords: Antidepressant efficacy, adverse effects, major depressive disorder, MDD symptomatology, severity, improved outcomes.