NIJMEGEN (The Thursday Times) — The antidepressant escitalopram does the best job of both easing depression and keeping it from coming back, according to a major analysis of clinical trials published in The Lancet Psychiatry.
An international team led by researchers at Radboud University Medical Center in the Netherlands pooled evidence from 115 randomised clinical trials involving more than 30,000 participants. They compared 20 antidepressants with one another and with fluoxetine, the best-known antidepressant, sold as Prozac.
Three medicines did better than fluoxetine at producing an improvement that lasted: escitalopram, agomelatine, and duloxetine. Patients on escitalopram were also less likely to stop taking their medicine. The researchers say it is the first large study to compare antidepressants over both short- and long-term use.
Not a reason to switch
“If you start an antidepressant, choose one that not only helps you to get well, but also keeps you well,” said Eric Ruhé, professor of difficult-to-treat depression at Radboud. He stressed that the balance between a medicine’s benefits and side effects differs from person to person, so the choice will still vary from patient to patient.
The study’s first author, Paul van Haaren, noted that agomelatine carries a risk of liver failure, while duloxetine is less often prescribed as a first treatment. Escitalopram is already widely used.
Independent experts said the differences were modest. Allan Young of the Royal College of Psychiatrists said they were “unlikely to outweigh individual factors such as side effects, previous response and patient preference”. Sameer Jauhar of Imperial College London said the research “cannot tell us which antidepressant will work best for an individual patient” and was no reason for someone doing well on their current medicine to change it.
What patients should know
Like all medicines, escitalopram can cause side effects, including sleep problems, constipation, and weight gain, though not everyone has them. Doctors generally advise people to stay on an antidepressant for at least six months after their depression lifts and then to come off it gradually, never suddenly, with medical advice.
Depression affects nearly six per cent of people worldwide, the researchers say. Anyone considering a change of treatment should speak to their doctor first.
