Condition

Depression

Major depressive disorder

332.4M
People Affected
10,000
Active Trials
357.4M
New Cases/Year
727K
Deaths/Year

Treatment Rankings

Ranked by evidence volume first. Medicine has spent centuries ranking things by vibes. This is an improvement.

1
Electroconvulsive Therapy (ECT)
90% Effectiveness• 95% Confidence• 40% Safety• 170 trials• 35K participants
HIGH EvidenceGood ValueDose: Individualized, based on seizure threshold
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Comparative Safety Scale(Higher is safer)

Cyanide☠️
Meth💀
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Chemo☢️
Alcohol🍺
Morphine💊
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40
DangerousModerateSafe

Time to Effect

1-2 weeks

Duration

Acute course: 6-12 sessions over 3-6 weeks; Maintenance: variable

Response Rate

80%

Remission Rate

60%

Number Needed to Treat (NNT)

3

Common Side Effects:

Memory loss (retrograde & anterograde): 50%
Headache: 35%
Nausea: 20%
Muscle aches: 15%
Confusion post-treatment: 15%

Annual Cost of Care

Drug Cost

$0

Monitoring

$25,000

Side Effects

$500

Total Annual

$25,500

Cost-Effectiveness

GOOD

QALYs Gained

0.7

ICER

$80,000/QALY

Cost per Remission

$42,500

Cost per Responder

$31,875

Treatment Outcomes
Primary Outcomes
Hamilton Depression Rating Scale (HAM-D) ScoreHAM-D score: 25/52 (Severe Depression)
-68% (-17 points)
Montgomery-Åsberg Depression Rating Scale (MADRS) ScoreMADRS score: 35/60 (Severe Depression)
-71.4% (-25 points)
Clinical Global Impression - Severity (CGI-S) ScoreCGI-S score: 5/7 (Markedly Ill)
-60% (-3 points)
Secondary Benefits
Quality of Life (SF-36 Mental Health Component Summary)SF-36 MHCS score: 30/100 (Poor Quality of Life)
+83.3% (+25 points)
Sheehan Disability Scale (SDS) ScoreSDS score: 20/30 (Significant Disability)
-75% (-15 points)
Hamilton Anxiety Rating Scale (HAM-A) ScoreHAM-A score: 25/56 (Moderate-Severe Anxiety)
-68% (-17 points)
Common Side Effects
Memory loss (retrograde & anterograde)
+50%
Headache
+35%
Nausea
+20%

Clinical Trial Phases:

Phase 4
2
Venlafaxine (SNRI)
80% Effectiveness• 90% Confidence• 60% Safety• 18 trials• 80K participants
HIGH EvidenceExcellent ValueDose: 75-225mg daily (extended-release)
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Comparative Safety Scale(Higher is safer)

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Meth💀
Cigarettes🚬
Chemo☢️
Alcohol🍺
Morphine💊
Antibiotics💉
Tylenol💊
Exercise🏃
Water💧
60
DangerousModerateSafe

Time to Effect

2-4 weeks

Duration

Acute: 6-12 weeks; Continuation: 4-9 months; Maintenance: 1-2+ years

Response Rate

62%

Remission Rate

40%

Number Needed to Treat (NNT)

8

Number Needed to Harm (NNH)

18

Common Side Effects:

Nausea: 35%
Insomnia: 25%
Sweating: 20%
Sexual dysfunction: 50%
Blood pressure increase: 10%

Annual Cost of Care

Drug Cost

$300

Monitoring

$1,000

Side Effects

$200

Total Annual

$1,500

Cost-Effectiveness

EXCELLENT

QALYs Gained

0.35

ICER

$40,000/QALY

Cost per Remission

$3,750

Cost per Responder

$2,419

Treatment Outcomes
Primary Outcomes
MADRS ScoreMADRS score: 28/60
-45% (-12.6 points)
HAM-D17 ScoreHAM-D17 score: 22/52
-40% (-8.8 points)
CGI-S ScoreCGI-S score: 4.5/7
-33.3% (-1.5 points)
GAF ScoreGAF score: 45/100
+33.3% (+15 points)
Secondary Benefits
Quality of Life (Q-LES-Q-SF Score)Q-LES-Q-SF score: 40/100
+37.5% (+15 points)
HAM-A ScoreHAM-A score: 25/56
-40% (-10 points)
Sleep Quality (PSQI Score)PSQI score: 14/21
-28% (-4 points)
Common Side Effects
Nausea
+35%
Insomnia
+25%
Sweating
+20%

Clinical Trial Phases:

Phase 4
3
Cognitive Behavioral Therapy (CBT)
78% Effectiveness• 95% Confidence• 95% Safety• 1408 trials• 50K participants
HIGH EvidenceGood ValueDose: 12-20 sessions, 45-60 minutes each, weekly
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Comparative Safety Scale(Higher is safer)

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Meth💀
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95
DangerousModerateSafe

Time to Effect

6-12 weeks (full course)

Duration

12-20 sessions over 3-6 months

Response Rate

65%

Remission Rate

50%

Number Needed to Treat (NNT)

5

Common Side Effects:

Temporary emotional distress: 8%
Increased anxiety during initial sessions: 8%

Annual Cost of Care

Drug Cost

$0

Monitoring

$2,250

Side Effects

$0

Total Annual

$2,250

Cost-Effectiveness

GOOD

QALYs Gained

0.5

ICER

$50,000/QALY

Cost per Remission

$4,500

Cost per Responder

$3,461

Treatment Outcomes
Primary Outcomes
Hamilton Depression Rating Scale (HAM-D) ScoreHAM-D score: 22/52 (moderate-severe depression)
-43% (-9.5 points)
Beck Depression Inventory-II (BDI-II) ScoreBDI-II score: 30/63 (moderate-severe depression)
-50% (-15 points)
Sheehan Disability Scale (SDS) ScoreSDS score: 18/30 (moderate functional impairment)
-50% (-9 points)
Secondary Benefits
Quality of Life Enjoyment and Satisfaction Questionnaire (Q-LES-Q) ScoreQ-LES-Q score: 40/100 (low quality of life)
+50% (+20 points)
Generalized Anxiety Disorder 7-item (GAD-7) Scale ScoreGAD-7 score: 14/21 (moderate anxiety)
-50% (-7 points)
Social Adjustment Scale - Self-Report (SAS-SR) Total ScoreSAS-SR score: 2.5/5 (moderate social impairment)
-40% (-1.0 points)
Common Side Effects
Temporary emotional distress
+8%
Increased anxiety during initial sessions
+8%

Clinical Trial Phases:

Phase 4
4
Sertraline (SSRI)
76% Effectiveness• 95% Confidence• 60% Safety• 81 trials• 100K participants
HIGH EvidenceExcellent ValueDose: 50-200mg daily
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Comparative Safety Scale(Higher is safer)

Cyanide☠️
Meth💀
Cigarettes🚬
Chemo☢️
Alcohol🍺
Morphine💊
Antibiotics💉
Tylenol💊
Exercise🏃
Water💧
60
DangerousModerateSafe

Time to Effect

2-4 weeks

Duration

Acute: 6-12 weeks; Continuation: 4-9 months; Maintenance: 1-2+ years

Response Rate

60%

Remission Rate

35%

Number Needed to Treat (NNT)

8

Number Needed to Harm (NNH)

18

Common Side Effects:

Nausea: 25%
Diarrhea: 20%
Sexual dysfunction: 50%
Insomnia/Somnolence: 15%
Headache: 18%

Annual Cost of Care

Drug Cost

$200

Monitoring

$1,000

Side Effects

$150

Total Annual

$1,350

Cost-Effectiveness

EXCELLENT

QALYs Gained

0.3

ICER

$35,000/QALY

Cost per Remission

$3,857

Cost per Responder

$2,250

Treatment Outcomes
Primary Outcomes
Depression Severity (HAM-D-17 Score)22 points (HAM-D-17 scale, range 0-52, indicating moderate-severe depression)
-50% (-11 points)
Patient-Reported Depression Severity (PHQ-9 Score)18 points (PHQ-9 scale, range 0-27, indicating moderately severe depression)
-45% (-8 points)
Clinical Global Impression - Severity (CGI-S Score)5 (CGI-S scale, range 1-7, 'Markedly Ill')
-40% (-2 points (e.g., from 'Markedly Ill' to 'Moderately Ill' or 'Mildly Ill'))
Secondary Benefits
Anxiety Symptoms (GAD-7 Score)15 points (GAD-7 scale, range 0-21, indicating severe anxiety)
-40% (-6 points)
Mental Health-Related Quality of Life (SF-36 MCS Score)38 points (SF-36 Mental Component Summary, scale 0-100, lower indicates worse QoL)
+20% (+7.6 points)
Functional Impairment (Work and Social Adjustment Scale - WSAS Score)25 points (WSAS scale, range 0-40, higher indicates greater impairment)
-30% (-7.5 points)
Common Side Effects
Nausea
+25%
Diarrhea
+20%
Sexual dysfunction
+50%

Clinical Trial Phases:

Phase 4
5
Mirtazapine
75% Effectiveness• 85% Confidence• 60% Safety• 67 trials• 50K participants
HIGH EvidenceExcellent ValueDose: 15-45mg daily
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Comparative Safety Scale(Higher is safer)

Cyanide☠️
Meth💀
Cigarettes🚬
Chemo☢️
Alcohol🍺
Morphine💊
Antibiotics💉
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Exercise🏃
Water💧
60
DangerousModerateSafe

Time to Effect

1-2 weeks (for sleep/appetite), 2-4 weeks (for mood)

Duration

Acute: 6-12 weeks; Continuation: 4-9 months; Maintenance: 1-2+ years

Response Rate

60%

Remission Rate

38%

Number Needed to Treat (NNT)

8

Number Needed to Harm (NNH)

18

Common Side Effects:

Sedation/Drowsiness: 40%
Weight gain: 25%
Increased appetite: 25%
Dry mouth: 15%

Annual Cost of Care

Drug Cost

$150

Monitoring

$1,000

Side Effects

$150

Total Annual

$1,300

Cost-Effectiveness

EXCELLENT

QALYs Gained

0.28

ICER

$30,000/QALY

Cost per Remission

$3,421

Cost per Responder

$2,167

Treatment Outcomes
Primary Outcomes
Hamilton Depression Rating Scale (HAM-D) scoreHAM-D score: 22/52
-45% (-10 points)
Montgomery-Asberg Depression Rating Scale (MADRS) scoreMADRS score: 30/60
-45% (-14 points)
Clinical Global Impression - Severity (CGI-S) scoreCGI-S score: 4/7
-38% (-1.5 points)
Secondary Benefits
Pittsburgh Sleep Quality Index (PSQI) scorePSQI score: 12/21
-25% (-3 points)
Body Weight70 kg
+7% (+5 kg)
Hamilton Anxiety Rating Scale (HAM-A) scoreHAM-A score: 20/56
-35% (-7 points)
Common Side Effects
Sedation/Drowsiness
+40%
Weight gain
+25%
Increased appetite
+25%

Clinical Trial Phases:

Phase 4
6
Esketamine (Nasal Spray)
72% Effectiveness• 80% Confidence• 45% Safety• 20 trials• 10K participants
MODERATE EvidencePoor ValueDose: 56mg or 84mg (induction), then weekly/bi-weekly
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Comparative Safety Scale(Higher is safer)

Cyanide☠️
Meth💀
Cigarettes🚬
Chemo☢️
Alcohol🍺
Morphine💊
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Exercise🏃
Water💧
45
DangerousModerateSafe

Time to Effect

Hours to days

Duration

Induction: 4 weeks (2x/week); Maintenance: weekly/bi-weekly, long-term

Response Rate

50%

Remission Rate

35%

Number Needed to Treat (NNT)

6

Common Side Effects:

Dissociation: 40%
Nausea/Vomiting: 25%
Vertigo: 25%
Sedation: 30%
Hypertension: 15%

Annual Cost of Care

Drug Cost

$40,000

Monitoring

$500

Side Effects

$300

Total Annual

$40,800

Cost-Effectiveness

POOR

QALYs Gained

0.4

ICER

$350,000/QALY

Cost per Remission

$116,571

Cost per Responder

$81,600

Treatment Outcomes
Primary Outcomes
MADRS Total ScoreMADRS score: 32/60 (severe depression)
-56.3% (-18 points)
Clinical Global Impression - Severity (CGI-S)CGI-S score: 5.5/7 (markedly ill)
-32.7% (-1.8 points)
Sheehan Disability Scale (SDS) Total ScoreSDS score: 20/30 (significant impairment)
-35% (-7 points)
Secondary Benefits
Hamilton Anxiety Rating Scale (HAM-A) Total ScoreHAM-A score: 25/56 (severe anxiety)
-36% (-9 points)
Q-LES-Q-SF Total ScoreQ-LES-Q-SF score: 30/100 (poor quality of life)
+60% (+18 points)
Insomnia Severity Index (ISI) Total ScoreISI score: 18/28 (moderate-severe insomnia)
-38.9% (-7 points)
Common Side Effects
Dissociation
+40%
Nausea/Vomiting
+25%
Vertigo
+25%

Clinical Trial Phases:

Phase 3Phase 4