Antidepressants equally effective; choice comes down to cost and side effects

When it comes to relieving depression, none of the 13 available second-generation antidepressants, such as Cymbalta, Prozac and Zoloft, are equally effective, according to a study out yesterday in the Annals of Internal Medicine.

After reviewing results from 234 studies published between 1980 and August 2011, researchers found no difference in effectiveness or quality of life for the second-generation antidepressants. The 13 medications included in the study: bupropion (Wellbutrin, Wellbutrin SR, Wellbutrin XL, and generic), citalopram (Celexa and generic), desvenlafaxine (Pristiq), duloxetine (Cymbalta), escitalopram (Lexapro), fluoxetine (Prozac and generic), fluvoxamine (Luvox and generic), mirtazapine (Remeron and generic), nefazodone (only available as a generic), paroxetine (Paxil, Paxil CR, and generic), sertraline (Zoloft and generic), trazodone (Desyrel), and venlafaxine (Effexor, Effexor XR, and generic).

All antidepressants can have side effects, but the study found that some are more likely to cause certain problems. For example, mirtazapine comes with a greater risk of weight gain, paroxetine is more likely to cause sexual dysfunction, and venlafaxine is associated with a heightened risk of nausea and vomiting.

Bottom line: This study reinforces earlier findings and recommendations from our Best Buy Drugs report that if you and your doctor decide you need an antidepressant, your choice should be based on a drug's cost and side effect profile. Our report also recommends five generics to consider as initial options: bupropion, citalopram, fluoxetine, paroxetine, or sertraline. All are substantially less expensive than brand-name antidepressants and are as effective for initial treatment. If you don't respond to the first one you try—and studies suggest that about 30 to 40 percent of people don't—your doctor might increase the dose or switch you to a different drug. It's not uncommon to try three or four antidepressants before finding one that works.

If there are specific side effects you are concerned about, discuss them with your doctor, who can help guide you to the best drug for you.

Read more about antidepressants in our free Best Buy Drugs report.

Source
Comparative Benefits and Harms of Second-Generation Antidepressants for Treating Major Depressive Disorder [Annals of Internal Medicine]

—Steve Mitchell