Editing Antidepressant (section)

===Major depressive disorder===
The UK [[National Institute for Health and Care Excellence]] (NICE)'s 2022 guidelines indicate that antidepressants should not be routinely used for the initial treatment of mild depression, "unless that is the person's preference".<ref name="NIHCE-2022">{{cite web|date=29 June 2022|title=Depression in adults: treatment and management|url=https://www.nice.org.uk/guidance/ng222/chapter/recommendations|website=National Institute for Health and Care Excellence}}</ref> The guidelines recommended that antidepressant treatment be considered:

* For people with a history of moderate or severe depression.
* For people with mild depression that has been present for an extended period.
* As a first-line treatment for moderate to severe depression.
* As a second-line treatment for mild depression that persists after other interventions.

The guidelines further note that in most cases, antidepressants should be used in combination with psychosocial interventions and should be continued for at least six months to reduce the risk of relapse and that SSRIs are typically better tolerated than other antidepressants.<ref name="NIHCE-2022" />

[[American Psychiatric Association]] (APA) treatment guidelines recommend that initial treatment be individually tailored based on factors including the severity of symptoms, co-existing disorders, prior treatment experience, and the person's preference. Options may include antidepressants, [[psychotherapy]], [[electroconvulsive therapy]] (ECT), [[transcranial magnetic stimulation]] (TMS), or [[light therapy]]. The APA recommends antidepressant medication as an initial treatment choice in people with mild, moderate, or severe major depression, and that should be given to all people with severe depression unless ECT is planned.<ref>{{cite web|author=Work Group on Major Depressive Disorder|url=https://psychiatryonline.org/pb/assets/raw/sitewide/practice_guidelines/guidelines/mdd.pdf|archive-url=https://ghostarchive.org/archive/20221009/https://psychiatryonline.org/pb/assets/raw/sitewide/practice_guidelines/guidelines/mdd.pdf|archive-date=9 October 2022|url-status=live|title=Practice Guideline for the Treatment of Patients With Major Depressive Disorder|edition=Third|publisher=American Psychiatric Association|date=October 2010}}</ref>

Reviews of antidepressants generally find that they benefit adults with depression.<ref name="CiprianiFurukawa2018"/><ref name="BarthKriston2018"/> On the other hand, some contend that most studies on antidepressant medication are confounded by several biases: the lack of an [[active placebo]], which means that many people in the placebo arm of a [[Randomized controlled trial|double-blind study]] may deduce that they are not getting any true treatment, thus destroying double-blindness; a short follow up after termination of treatment; non-systematic recording of adverse effects; very strict exclusion criteria in samples of patients; studies being paid for by the industry; selective publication of results. This means that the small beneficial effects that are found may not be statistically significant.<ref>{{cite journal|vauthors=Moncrieff J, Kirsch I|title=Empirically derived criteria cast doubt on the clinical significance of antidepressant-placebo differences|journal=Contemporary Clinical Trials|volume=43|pages=60–62|date=July 2015|pmid=25979317|doi=10.1016/j.cct.2015.05.005|doi-access=free}}</ref><ref>{{cite book|title=The Emperor's New Drugs: Exploding the Antidepressant Myth|publisher=Basic Books|date=2010|vauthors=Kirsch I|pages=[https://archive.org/details/emperorsnewdrugs0000kirs/page/80 80]|isbn=978-0-465-02016-4|title-link=The Emperor's New Drugs: Exploding the Antidepressant Myth}}</ref><ref>{{cite journal|vauthors=Antonuccio DO, Burns DD, Danton WG|date=2002|title=Antidepressants: a triumph of marketing over science?|journal=Prevention and Treatment|volume=5|doi=10.1037/1522-3736.5.1.525c}}</ref><ref>{{cite journal|vauthors=Antonuccio DO, Danton WG, DeNelsky GY, Greenberg RP, Gordon JS|title=Raising questions about antidepressants|journal=Psychotherapy and Psychosomatics|volume=68|issue=1|pages=3–14|date=1999|pmid=9873236|doi=10.1159/000012304|s2cid=13524296}}</ref><ref name=BMJ2019/>

Among the 21 most commonly prescribed antidepressants, the most effective and well-tolerated are [[escitalopram]], [[paroxetine]], [[sertraline]], [[agomelatine]], and [[mirtazapine]].<ref name="NIHR-2018" /><ref name="CiprianiFurukawa2018" /> For children and adolescents with moderate to severe depressive disorder, some evidence suggests [[fluoxetine]] (either with or without [[cognitive behavioral therapy]]) is the best treatment, but more research is needed to be certain.<ref name="Evidence-2020">{{cite journal|date=12 October 2020|title=Prozac may be the best treatment for young people with depression – but more research is needed|url=https://evidence.nihr.ac.uk/alert/prozac-may-be-the-best-treatment-for-young-people-with-depression-but-more-research-is-needed/|journal=NIHR Evidence|type=Plain English summary|publisher=National Institute for Health and Care Research|doi=10.3310/alert_41917|s2cid=242952585}}</ref><ref name="Zhou-2020">{{cite journal|vauthors=Zhou X, Teng T, Zhang Y, Del Giovane C, Furukawa TA, Weisz JR, Li X, Cuijpers P, Coghill D, Xiang Y, Hetrick SE, Leucht S, Qin M, Barth J, Ravindran AV, Yang L, Curry J, Fan L, Silva SG, Cipriani A, Xie P|title=Comparative efficacy and acceptability of antidepressants, psychotherapies, and their combination for acute treatment of children and adolescents with depressive disorder: a systematic review and network meta-analysis|journal=The Lancet. Psychiatry|volume=7|issue=7|pages=581–601|date=July 2020|pmid=32563306|pmc=7303954|doi=10.1016/S2215-0366(20)30137-1}}</ref><ref name="Boaden-2020">{{cite journal|vauthors=Boaden K, Tomlinson A, Cortese S, Cipriani A|title=Antidepressants in Children and Adolescents: Meta-Review of Efficacy, Tolerability and Suicidality in Acute Treatment|journal=Frontiers in Psychiatry|volume=11|pages=717|date=2 September 2020|pmid=32982805|pmc=7493620|doi=10.3389/fpsyt.2020.00717|doi-access=free}}</ref><ref name="Hetrick-2021">{{cite journal|vauthors=Hetrick SE, McKenzie JE, Bailey AP, Sharma V, Moller CI, Badcock PB, Cox GR, Merry SN, Meader N|title=New generation antidepressants for depression in children and adolescents: a network meta-analysis|journal=The Cochrane Database of Systematic Reviews|volume=2021|issue=5|pages=CD013674|date=May 2021|pmid=34029378|pmc=8143444|doi=10.1002/14651858.CD013674.pub2|collaboration=Cochrane Common Mental Disorders Group}}</ref> Sertraline, escitalopram, and [[duloxetine]] may also help reduce symptoms.<ref name="Hetrick-2021" />

A 2023 [[systematic review]] and [[meta-analysis]] of [[randomized controlled trial]]s of antidepressants for major depressive disorder found that the medications provided only small or doubtful benefits in terms of [[quality of life]].<ref name="pmid36905396">{{cite journal|vauthors=Wiesinger T, Kremer S, Bschor T, Baethge C|title=Antidepressants and Quality of Life in Patients with Major Depressive Disorder – Systematic Review and Meta-analysis of Double-blind, Placebo-controlled RCTs|journal=Acta Psychiatr Scand|volume=147|issue=6|pages=545–560|date=March 2023|pmid=36905396|doi=10.1111/acps.13541|s2cid=257438412|doi-access=free}}</ref> Likewise, a 2022 systematic review and meta-analysis of randomized controlled trials of antidepressants for major depressive disorder in children and adolescents found small improvements in quality of life.<ref name="pmid35508443">{{cite journal|vauthors=Teng T, Zhang Z, Yin B, Guo T, Wang X, Hu J, Ran X, Dai Q, Zhou X|title=Effect of antidepressants on functioning and quality of life outcomes in children and adolescents with major depressive disorder: a systematic review and meta-analysis|journal=Transl Psychiatry|volume=12|issue=1|pages=183|date=May 2022|pmid=35508443|pmc=9068747|doi=10.1038/s41398-022-01951-9}}</ref> Quality of life as an outcome measure is often selectively reported in trials of antidepressants.<ref name="Paludan-Müller 2021">{{cite journal|vauthors=Paludan-Müller AS, Sharma T, Rasmussen K, Gøtzsche PC|title=Extensive selective reporting of quality of life in clinical study reports and publications of placebo-controlled trials of antidepressants|journal=Int J Risk Saf Med|volume=32|issue=2|pages=87–99|date=May 2021|pmid=33044196|doi=10.3233/JRS-200051|s2cid=222299860}}</ref>