Which first-line antidepressant?

Choice of first-line antidepressants for depression has been debated in psychiatric journals over the last 9 months, in relation to the widely reported meta-analysis by Cipriani et al in the Lancet, comparing 21 antidepressants for efficacy and tolerability. 1 They found that agomelatine, amitriptyline, escitalopram, mirtazapine, paroxetine, venlafaxine, and vortioxetine were more effective than other antidepressants. 1 They also found agomelatine, citalopram, escitalopram, fluoxetine, sertraline, and vortioxetine to be relatively better tolerated than others. 1 Three antidepressants with higher efficacy also had relatively high acceptability: agomelatine, escitalopram, and vortioxetine. So should these antidepressants now be considered firstline choices for depression in primary care?