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SSRIs and tricyclic antidepressants do not differ substantially in either cost-effectiveness or efficacy, a major NHS trial reports.

The Health Technology Assessment, which will inform future NICE guidance, concluded that the first choice

of antidepressant should be based on doctor and patient choice.

The year-long study of 327 patients found no significant difference in the number of depression-free weeks in patients treated with tricyclic

antidepressants, lofepramine or SSRIs.

Tricyclic antidepressants were the least likely to be cost-effective as first choice of antidepressant but the differences were not significant.

Patients on lofepramine were significantly more likely than those on other anti-

depressants to have to switch drug in the first few weeks.

Study leader Dr Michael Moore, a GP in Salisbury and senior lecturer in general practice at the University of Southampton, said choosing the drug on the basis of

patient preference would help reduce the incidence of switching.

He said: 'SSRIs are prescribed more commonly and are very easy to use but if the patient doesn't want an SSRI it's reasonable to go with their choice. The most effective thing is the patient continuing to take the drug so getting people to agree with the treatment seems a good strategy.'

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