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Sertraline and escitalopram 'better than NICE-recommended antidepressants'

By Lilian Anekwe

Two antidepressants not recommended by NICE work better than approved first-line treatments in patients with moderate to severe depression, a comprehensive meta-analysis concludes.

The major international study of the efficacy of 12 second-generation antidepressants found there were ‘clinically important differences' between them.

Drop-out rates from treatment also differed substantially, concluded the study, published in The Lancet last week.

Sertraline and escitalopram – neither of which are recommended first-line in the NICE depression guidelines – fared better than citalopram and fluoxetine, which the guidance favours.

Escitalopram was 32% more efficacious, and sertraline 25% more efficacious, than fluoxetine.

The international team included UK researchers from Oxford, Cambridge, Bristol and the Cochrane review group at the Institute of Psychiatry at King's College, London.

They concluded: ‘Sertaline might be the best choice when starting treatment for moderate to severe major depression in adults because it has the most favourable balance between benefits, acceptability and acquisition cost.'

Dr Sagar Parikh, a psychiatrist at the University Health Network in Toronto, Canada, claimed in an accompanying editorial that the findings had ‘enormous implications'.

He added: ‘Now, the clinician can identify the best treatments, identify individual side-effect profiles, explore costs and patients' preferences, and collaborate in identifying the best treatment for that patient.'

The review, of 117 randomised controlled trials in over 25,000 patients prescribed antidepressants between 1991 and 2007, compared bupropion, citalopram, duloxetine, escitalopram, fluoxetine, fluvoxamine, milnacipran, mirtazapine, paroxetine, reboxetine, sertraline, and venlafaxine.

Researchers conducted two analyses: of efficacy, by measuring which patients showed at least a 50% reduction at week eight, and acceptability, measured as dropout rates for any reason during the first eight weeks of treatment.

Table: Antidepressant prescribing courtesy of Cegedim Strategic Data

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