Antidepressant Comparative Efficacy — MRCPsych Paper B MCQ
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Correct answer: C — Agomelatine, amitriptyline, escitalopram, mirtazapine, paroxetine, venlafaxine and vortioxetine were in the more-effective group; fluoxetine, fluvoxamine, reboxetine and trazodone were least efficacious
Explanation lettering: C = shown as A · D = shown as B · B = shown as C · A = shown as D
Option B reproduces the head-to-head efficacy findings. Agomelatine, amitriptyline, escitalopram, mirtazapine, paroxetine, venlafaxine and vortioxetine were more effective than other antidepressants, whereas fluoxetine, fluvoxamine, reboxetine and trazodone comprised the least-efficacious group. All 21 antidepressants were nevertheless more effective than placebo. Options A and C incorrectly substitute citalopram or sertraline and misclassify fluvoxamine or paroxetine. Option D largely confuses efficacy with acceptability: citalopram, fluoxetine and sertraline had comparatively favourable acceptability, while amitriptyline, duloxetine and venlafaxine had higher dropout rates. Option E incorrectly substitutes duloxetine for amitriptyline. These rankings describe average trial outcomes and should not alone determine treatment for an individual patient.
Reference: Cipriani A et al. Comparative efficacy and acceptability of 21 antidepressant drugs for the acute treatment of adults with major depressive disorder: a systematic review and network meta-analysis. The Lancet. 2018;391:1357-1366. https://pubmed.ncbi.nlm.nih.gov/29477251/