All antidepressant drugs are not created equal, according to the authors of one of the few studies that have ever systematically analyzed and compared "new generation" medicines for treating depression. 

What qualities are important in an anti-depressant? Efficacy? Tolerance? Side effects? Cost? 

In the analysis of 12 drugs, two came out on top as the most effective and best tolerated as first-line treatments: sertraline (Zoloft) and escitalopram (Lexapro). Venlafaxine (Effexor) and mirtazapine (Remeron) rounded out the top four for effectiveness, but venlafaxine was also among the four drugs patients were most likely to quit taking because of side effects. Reboxetine (Edronax) was less effective than the rest. 

While psychiatrists treating depressed patients every day have had a sense of which medications are best, the current study "nails it," says Sagar V. Parikh, M.D., of the University of Toronto. Parikh, who wrote a comment accompanying the study that is published in the current issue of The Lancet, says the findings have "enormous implications" because, for the first time, they offer doctors an evidence-based, unbiased way to recommend treatment. And, he adds, they give patients a "gold standard of reliable information," especially since the study's authors plan to make their findings available free on the Web. 

Not so fast, says Gerald Gartlehner, M.D., M.P.H., who coauthored a review of the benefits and risks of the same 12 drugs published last November in the Annals of Internal Medicine. He and his colleagues concluded, based on their review done while Gartlehner was at the RTI-UNC Evidence-Based Practice Center in Chapel Hill, North Carolina., that there was no clinically meaningful evidence that any one of the drugs was better than the rest. Instead, they argued, decisions on which drug to use should be based on factors such as cost and side effects. 
How many different drugs were analyzed?
And what kind of drugs were they?
Were they all found to be equally effective?
Were any identified as being the most effective?
Which?
Were any of them definitively the least effective?
Which one?
Did they print the results in a journal?
Which one?
Were the results important?
Who suggested that?
And what's his profession?
Where does he work?
Is there universal agreement that the results were important?
Who believes that?
Do his coworkers believe it too?
Where did they do their work leading to that conclusion?
In what state?
And what do their results suggest on the other hand?
Did they publish their work too?
12
In the analysis of 12 drugs
antidepressants
have ever systematically analyzed and compared "new generation" medicines for treating depression
no
In the analysis of 12 drugs, two came out on top as the most effective
yes
two came out on top
sertraline and escitalopram
 two came out on top as the most effective and best tolerated as first-line treatments: sertraline (Zoloft) and escitalopram (Lexapro)
yes
 Reboxetine (Edronax) was less effective than the rest. 
Reboxetine
Reboxetine (Edronax) was less effective than the rest. 
yes
 the study that is published in the current issue of The Lancet
The Lancet
that is published in the current issue of The Lancet
yes
the findings have "enormous implications" 
Sagar V. Parikh
Sagar V. Parikh, M.D., of the University of Toronto. Parikh, who wrote a comment accompanying the study
a doctor
 Sagar V. Parikh, M.D
University of Toronto
Sagar V. Parikh, M.D., of the University of Toronto
no
Not so fast, says Gerald Gartlehner
Gerald Gartlehner
Not so fast, says Gerald Gartlehner, M.D., M.P.H
yes
He and his colleagues concluded
at the RTI-UNC
their review done while Gartlehner was at the RTI-UNC
North Carolina
at the RTI-UNC Evidence-Based Practice Center in Chapel Hill, North Carolina
none the drugs was better than the rest.
 that there was no clinically meaningful evidence that any one of the drugs was better than the rest.
yes
 published last November in the Annals of Internal Medicine