Escitalopram beats Prozac for lasting depression relief

Escitalopram, agomelatine and duloxetine did better than fluoxetine at helping people with depression get well and stay well, according to a network meta-analysis published November 10 in The Lancet Psychiatry. The researchers pooled 115 randomized trials with more than 30,000 participants. Independent experts said the gaps between drugs are modest. They also said the results are no reason for patients who are doing well on their current medication to switch.medicalxpress.com

Most antidepressant trials run about eight weeks, but many patients take the drugs for much longer. Until now, there has been little research comparing how individual medications perform beyond that window.nytimes.com

What the analysis found

The team, which included researchers from Radboud University Medical Center and Kyoto University, compared 21 antidepressants against fluoxetine, sold as Prozac Eli Lilly and Company ↗ 1.44%. They looked at trials lasting more than 12 weeks and checked for "sustained response," meaning symptom improvement that held until the end of the study (Kyoto University; The New York Times). Escitalopram, duloxetine and agomelatine had higher sustained-response rates than fluoxetine. Escitalopram and duloxetine also had lower rates of patients stopping treatment for any reason. Sertraline did no better than fluoxetine, while bupropion and reboxetine did worse than several other drugs.bbc.com+2

"Of these SSRIs, escitalopram now appears to be the most effective, also for long-term use," said Eric Ruhé, a professor at Radboud. He added that the study "may have implications for future treatment guidelines." First author Paul van Haaren noted that agomelatine carries a risk of liver failure.medicalxpress.com

Experts urge caution

Sameer Jauhar of Imperial College London pointed out that the main drug-by-drug comparison used only 35 trials with about 10,000 people. More than half of those trials were judged at high risk of bias, and follow-up typically lasted around six months. The analysis also found that about 62% of people who kept taking antidepressants maintained their improvement, compared with 45% of those switched to placebo.sciencemediacentre.es

"I would not interpret these findings as a reason for someone who is responding well to their current antidepressant to change treatment," Jauhar said.bbc.com

Choosing a first drug

Allan Young of the Royal College of Psychiatrists said the differences "are modest and are unlikely to outweigh individual factors such as side effects, previous response and patient preference". Ruhé agreed that the right choice varies by patient, but said the evidence should guide the first prescription: "if you start an antidepressant, choose one that not only helps you to get well, but also keeps you well".bbc.com+1