One antidepressant ranks above the rest in a large analysis of how well these medicines keep patients free of depression symptoms. Escitalopram performed best at preventing patients from relapsing, according to the findings.
The results came from a study involving nearly 10,000 people who were prescribed different medications for up to a year. The analysis, published in The Lancet Psychiatry, drew on earlier studies that compared more than a dozen common antidepressants in total.
How the antidepressants compared in the analysis
Two other drugs, agomelatine and duloxetine, came next in the rankings. Prozac, also known as fluoxetine, placed just below them.
Compared with Prozac, the analysis found that:
- people taking escitalopram were more likely to see their symptoms improve and stay that way
- people taking escitalopram were less likely to stop their medication
- agomelatine, an atypical antidepressant, and duloxetine, a serotonin and noradrenaline reuptake inhibitor, also performed well
- other medicines, including sertraline, were no better
The differences between the drugs were modest, and experts said longer studies are still needed to learn more.
Experts urge caution over what the findings mean
Experts stressed that the findings do not mean everyone with severe depression should switch to escitalopram. They also said other antidepressants are not without value, because each drug can work and each has its own pros and cons.
Prof Eric Ruhé of Radboud University in the Netherlands, one of the researchers, said the choice of medication can vary for each individual. He said the study could help prescribers and patients make decisions together. “If you start an antidepressant, choose one that not only helps you to get well, but also keeps you well,” he said.
Dr Sameer Jauhar of Imperial College London said the research offered useful information but “it cannot tell us which antidepressant will work best for an individual patient.” He said he would not read the findings as a reason for someone responding well to their current medicine to change treatment.
Prof Allan Young of the Royal College of Psychiatrists said some medicines appear to have a small advantage over others in the longer term. However, he said the differences are modest and are unlikely to outweigh factors such as side effects, previous response and patient preference.
Relapse prevention and guidance on treatment
Depression is common, affecting around one in six people in the UK. With the right treatment and support, people can make a good recovery, although for some the depression can return.
Doctors already recommend that people stay on antidepressants for at least six months after depression ends, then taper off gradually to prevent relapse. Many medical guidelines list selective serotonin reuptake inhibitors, including escitalopram, sertraline and fluoxetine, as the first choice of drug.
Like all medicines, escitalopram can cause side effects, including sleep problems, constipation and weight gain, although not everyone experiences them. The NHS says doctors may suggest a different type of antidepressant, such as an SNRI, if an SSRI is ineffective or unsuitable.
The mental health charity Mind said people need clear information about the possible benefits and side effects of antidepressants, as well as access to other support such as talking therapies. “It’s common for people to need to try more than one medication before they find the right treatment that works for them. And what works may change over time,” the charity said.
