Escitalopram ranks top for relapse prevention, experts say

Researchers reviewing antidepressant use have concluded that escitalopram was the most effective option for keeping people from falling back into depression. The findings appear in The Lancet Psychiatry, and the study pooled earlier work comparing more than a dozen widely used medicines.

The analysis drew on nearly 10,000 people who had been given different drugs for as long as a year. Agomelatine and duloxetine followed in the ranking, with Prozac, also called fluoxetine, sitting just beneath them.

What the findings show

Compared with Prozac, those taking escitalopram were more likely to have symptoms ease and remain eased. They also tended to stop their treatment less often. Agomelatine, an atypical antidepressant, and duloxetine, a selective noradrenaline reuptake inhibitor, also did well. Sertraline was not shown to outperform the other drugs.

Experts noted that the gaps between the drugs were small. They were clear that the results do not justify moving every patient with serious depression onto escitalopram. Other antidepressants remain useful, and each has its own strengths and drawbacks.

Expert reaction

Prof Eric Ruhé of Radboud University in The Netherlands said the right medicine may differ from one person to another. He added that the study could guide prescribers and patients as they decide together on a drug that both treats and maintains recovery.

Dr Sameer Jauhar of Imperial College London said the work was helpful but could not predict the best drug for a single person. He advised against changing medicine for anyone already doing well on their current treatment.

Prof Allan Young of the Royal College of Psychiatrists said some drugs show slight longer-term benefits, yet those gaps are small. In his view, side effects, past reactions and what the patient prefers should carry more weight.

Background on depression and treatment

Around one in six UK residents are affected by the condition, according to the reports. Most can recover with suitable care and backing, though relapse happens in some cases. Current advice is to keep taking antidepressants for a minimum of half a year once symptoms lift, then reduce the dose slowly.

Many guidelines place SSRIs such as escitalopram, sertraline and fluoxetine at the top of the list for first treatment. These medicines raise serotonin, a chemical tied to mood. Escitalopram may cause sleep trouble, constipation or weight gain, though many users have none of these effects. If an SSRI does not help or is unsuitable, the NHS says doctors may turn to another class, such as an SNRI.

The mental health charity Mind stresses that people should be given plain information on what antidepressants can do and their possible side effects. It also points to talking therapy and mindfulness as other options. Mind notes that many people have to try more than one drug before finding a good fit, and that what helps can shift over time.

Frequently asked questions

Sources

• BBC News: Antidepressant escitalopram more effective at preventing relapse, analysis finds

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