Escitalopram (Lexapro), duloxetine (Cymbalta) and agomelatine (Thymanax) outperformed fluoxetine (Prozac) at producing lasting symptom improvement in adults with major depressive disorder, according to a meta-analysis published Nov. 10 in The Lancet Psychiatry and reported by The New York Times.
Researchers compared 21 antidepressants across 115 published and unpublished studies that followed patients for more than 12 weeks, one of them for two years. They measured sustained response, meaning improvement that held through the end of a trial, and treated discontinuation for any reason as a sign that the drug wasn’t working. Fluoxetine served as the benchmark because it is so widely prescribed.
Here are six things to know:
1. Most antidepressants performed about as well as fluoxetine. Patients taking escitalopram, duloxetine or agomelatine, which is not sold in the US, were more likely to improve and to stay improved.
2. Bupropion (Wellbutrin, Zyban) and reboxetine performed worse than many other antidepressants.
3. Patients who stayed on medication did better. Among patients who had already improved on an antidepressant, about 62% who kept taking it for six months or longer maintained that improvement. That compared with roughly 45% of patients switched to placebo.
4. The findings matter most for patients starting treatment. Henricus Ruhé, MD, PhD, a professor of psychiatry at Radboud University Medical Center in the Netherlands and a lead researcher, said the findings offer less reason to switch a drug that already works. “Why change a winning team?” Dr. Ruhé said.
5. The study has limitations. About half of the studies carried a high risk of bias, data beyond one year were scarce, and the researchers could not break out results by gender or ethnicity.
6. Long-term evidence lags long-term use. Typical trials last about eight weeks, yet a quarter of people who have taken antidepressants did so for 10 years or more, according to the CDC. Gerard Sanacora, MD, PhD, director of the Yale Depression Research Program in New Haven, Conn., said the analysis does not replace the need for real-world data.
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