Many medical guidelines recommend SSRI (selective serotonin reuptake inhibitor) antidepressants, like escitalopram, sertraline and fluoxetine or Prozac, as the first drug of choice.
These drugs increase seratonin, which is linked to mood.
According to the new analysis, compared to Prozac (fluoxetine):
people on escitalopram were more likely to see their symptoms improve and stay that way, and less likely to stop taking their medication
agomelatine (an atypical antidepressant) and duloxetine (an SNRI or selective noradrenaline reuptake inhibitor) also performed well
other medicines, including sertraline, were no better
One of the researchers, Prof Eric Ruhé at Radboud University in The Netherlands, said the choice of medication can vary for each individual.
“Nevertheless, our study can help inform the decisions that prescribers and patients make together: if you start an antidepressant, choose one that not only helps you to get well, but also keeps you well.”
Dr Sameer Jauhar, an expert at Imperial College London, said while the research provided useful information, “it cannot tell us which antidepressant will work best for an individual patient.”
“I would not interpret these findings as a reason for someone who is responding well to their current antidepressant to change treatment,” he added.
Prof Allan Young from the Royal College of Psychiatrists said: “While some medicines appear to have a small advantage over others for longer-term outcomes, the differences are modest and are unlikely to outweigh individual factors such as side effects, previous response and patient preference when deciding on treatment.”
Like all medicines, escitalopram can cause side effects, including sleep problems, constipation and weight gain, although not everyone experiences them.
The NHS says, external if escitalopram or a similar SSRI is ineffective or not suitable, doctors may suggest a different type of antidepressant, such as an SNRI.
Older tricyclic antidepressants, such amitriptyline, are now less commonly prescribed.
The mental health charity Mind says people need access to clear information about the potential benefits and side effects of antidepressants as well as other forms of support, including talking therapies and mindfulness.
“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.
Mind’s website, external has information to help compare different antidepressants.
