Authors' response

By taking part of a single sentence out of context, Sumeet Gupta misrepresents our article. We wrote: ‘Controlled studies have suggested favourable efficacy and tolerability profiles; however, agomelatine is not without its controversies, with recent meta-analyses showing only marginal advantages over placebo’ (our italics). We also stated that, ‘although narrative reviews of the efficacy of agomelatine emphasise its superior efficacy relative to placebo and certain other antidepressants such as sertraline and fluoxetine, formal meta-analyses have found these effects to be less convincing and of uncertain clinical significance’ (the meta-analysis by Koesters et al ¹ had not been published when we submitted our article, so we relied on that of Singh et al ² which reaches similar conclusions). Merely reading the abstract is enough to encounter the phrase: ‘Current meta-analyses show marginal clinical benefits of agomelatine relative to placebo’. Overall, our conclusion is similar to that of Koesters et al ¹ : ‘The present systematic review found that acute treatment with agomelatine is associated with a difference of 1.5 points on the HRSD. This difference was statistically significant, although the clinical relevance of this small effect is questionable’.

Drug companies are often accused, with justification, of making exaggerated and misleading claims. Their critics should avoid emulating them.