Best Antidepressant May Depend on Patient:
MONDAY, Dec. 5 (HealthDay News) -- Newer antidepressants seem to
be about as effective as one another, a new analysis indicates.
This suggests that the choice of which drug is appropriate for
which patient should be made on the basis of such considerations as
side effects, cost and patient preference.
"They're all equally effective," said Dr. David Schlager, a clinical assistant professor of psychiatry and behavioral science at Texas A&M Health Science Center College of Medicine.
"They're interchangeable except for side effects," he added, so psychiatrists do tend to "exploit the side-effect profile" to find suitable medications for individual patients, he added.
According to the background information in the new study,
appearing in the Dec. 6 issue of
Annals of Internal Medicine, some 27 million people in the United States had taken antidepressants as of 2005.
Most of these drugs are "second-generation" medications such as
selective serotonin reuptake inhibitors (SSRIs), norepinephrine
reuptake inhibitors (SNRIs) and related drugs.
SSRIs include the best-selling Prozac (fluoxetine) and Zoloft
(sertraline). An example of an SNRI is Effexor (venlafaxine).
Led by Dr. Gerald Gartlehner, the analysis was funded primarily
by the U.S. Agency for Healthcare Research and Quality.
Authors reviewed data from 234 previously published studies, all
of them randomized trials that had included at least 1,000
While there was no difference in drug effectiveness, there were
distinctions in how quickly a drug took effect, side effects and
quality of life.
For instance, the authors said, Remeron (mirtazapine) takes
effect faster than Prozac, Zoloft, Paxil (paroxetine) or Celexa
Bupropion, which goes by Wellbutrin and other brand names, has
fewer adverse sexual effects than Prozac, Zoloft, Paxil or Lexapro
"If a patient has insomnia, you would pick something more immediately sedating," said Schlager, who is also a psychiatrist with Lone Star Circle of Care in Austin. "If the patient has decreased appetite and weight loss, you would pick something more likely to cause weight gain like mirtazapine."
Cost, of course, is another consideration.
"If one drug costs $200 a month and another costs $20, I don't see any reason why not to go with the latter," said Dr. Radu Saveanu, a professor of psychiatry at the University of Miami Miller School of Medicine.
Dosing is also important, he said, "because studies have shown
that if patients have to take the drug less frequently, compliance
is higher, which will make a big difference in terms of
But given the similarity in effectiveness, prescribing
antidepressants is still largely a trial-and-error process.
It's hoped that the next series of studies will provide guidance
on which medications to try first.
"The real heart of the matter is, if they don't respond to one type of antidepressant, is there any guidelines about what you should try next?" Schlager said.
The U.S. National Library of Medicine has more on
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