ORIGINAL PAPER General and comparative efficacy and effectiveness of antidepressants in the acute treatment of depressive disorders: a report by the WPA section of pharmacopsychiatry Thomas C. Baghai • Pierre Blier • David S. Baldwin • Michael Bauer • Guy M. Goodwin • Kostas N. Fountoulakis • Siegfried Kasper • Brian E. Leonard • Ulrik F. Malt • Dan Stein • Marcio Versiani • Hans-Ju ¨rgen Mo ¨ller • for the Section of Pharmacopsychiatry, World Psychiatric Association Ó Springer-Verlag 2011 Abstract Current gold standard approaches to the treat- ment of depression include pharmacotherapeutic and psy- chotherapeutic interventions with social support. Due to current controversies concerning the efficacy of antidepres- sants in randomized controlled trials, the generalizability of study findings to wider clinical practice and the increasing importance of socioeconomic considerations, it seems timely to address the uncertainty of concerned patients and relatives, and their treating psychiatrists and general practitioners. We therefore discuss both the efficacy and clinical effectiveness of antidepressants in the treatment of depressive disorders. We explain and clarify useful measures for assessing clinically meaningful antidepressant treatment effects and the types of studies that are useful for addressing uncertainties. This includes considerations of methodologi- cal issues in randomized controlled studies, meta-analyses, and effectiveness studies. Furthermore, we summarize the differential efficacy and effectiveness of antidepressants with distinct pharmacodynamic properties, and differences between studies using antidepressants and/or psychotherapy. The Section of Pharmacopsychiatry World Psychiatric Association is given in the Appendix. T. C. Baghai  H.-J. Mo ¨ller Department of Psychiatry and Psychotherapy, Ludwig-Maximilian-University of Munich, Nußbaumstraße 7, 80336 Munich, Germany T. C. Baghai (&) Department of Psychiatry and Psychotherapy, University Regensburg, Universita ¨tsstraße 84, 93053 Regensburg, Germany e-mail: Thomas.Baghai@medbo.de P. Blier Department of Psychiatry, University of Ottawa, Ottawa, Canada D. S. Baldwin University Department of Psychiatry, University of Southampton, Southampton, UK M. Bauer University Hospital Carl Gustav Carus, Dresden, Germany G. M. Goodwin University Department, Warneford Hospital, Oxford, UK K. N. Fountoulakis 3rd Department of Psychiatry, Aristotle University of Thessaloniki, Thessaloniki, Greece S. Kasper Department of Psychiatry and Psychotherapy, Medical University of Vienna, Vienna, Austria B. E. Leonard National University of Ireland, Galway, Ireland U. F. Malt Department of Neuropsychiatry and Psychosomatic Medicine, Oslo University Hospital, Oslo, Norway D. Stein MRC Unit of Anxiety Disorders, University of Stellenbosch, Cape Town, South Africa M. Versiani Department of Psychiatry, Federal University of Rio de Janeiro, Rio de Janeiro, Brazil 123 Eur Arch Psychiatry Clin Neurosci (2011) 261 (Suppl 3):S207–S245 DOI 10.1007/s00406-011-0259-6