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Interesting, thanks for posting. I have been wanting to see a recent study like this for some time. Have you guys ever even heard of Agomelatine? I'm not familiar with that one at all.

(From link above) Outcome (for acute treatment of Major Depressive Disorder):

In head-to-head studies, agomelatine, amitriptyline, escitalopram, mirtazapine, paroxetine, venlafaxine, and vortioxetine were more effective than other antidepressants (range of ORs 1·19–1·96), whereas fluoxetine, fluvoxamine, reboxetine, and trazodone were the least efficacious drugs (0·51–0·84). For acceptability, agomelatine, citalopram, escitalopram, fluoxetine, sertraline, and vortioxetine were more tolerable than other antidepressants (range of ORs 0·43–0·77), whereas amitriptyline, clomipramine, duloxetine, fluvoxamine, reboxetine, trazodone, and venlafaxine had the highest dropout rates (1·30–2·32). 46 (9%) of 522 trials were rated as high risk of bias, 380 (73%) trials as moderate, and 96 (18%) as low; and the certainty of evidence was moderate to very low.

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4 hours ago, dancesintherain said:

anyone know what " the certainty of evidence was moderate to very low " means?  Is that essentially saying that the study results can't be trusted or does it mean something else?

Based on another section I believe they are describing the predicted reliability of the studies they included in the meta-analysis. From the snippet below the results around the first list of meds should carry more weight than those about the second list.


We incorporated the GRADE judgments in figure 4. The certainty of evidence for the relative treatment effects of efficacy and acceptability varied; it was moderate for most of the comparisons involving agomelatine, escitalopram, citalopram, and mirtazapine, and low to very low for most comparisons involving vortioxetine, nefazadone, clomipramine, bupropion, and amitriptyline 

I've been getting good use out of a meta analysis I found on treatment-resistant depression. I'll link it in case anyone else might find it useful https://www.ncbi.nlm.nih.gov/pubmed/26425446


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