Antidepressant escitalopram more effective at preventing relapse, analysis finds

A new analysis has concluded that escitalopram reduces the risk of depression relapse more than fluoxetine (Prozac). The research compared outcomes for patients on the two drugs and found better symptom improvement and lower discontinuation rates for escitalopram. The study also noted that many clinical guidelines list SSRIs such as escitalopram, sertraline and fluoxetine as first‑line treatments.

The investigators reported that, in addition to escitalopram, the atypical antidepressant agomelatine and the SNRI duloxetine performed well in the analysis. By contrast, other medicines, including sertraline, showed no clear advantage over fluoxetine. These findings suggest modest differences between drugs for long‑term outcomes.

Prof Eric Ruhé of Radboud University in the Netherlands, one of the authors, said the choice of medication can vary for each individual. He added, "Nevertheless, our study can help inform the decisions that prescribers and patients make together: if you start an antidepressant, choose one that not only helps you to get well, but also keeps you well." Dr Sameer Jauhar of Imperial College London warned, "it cannot tell us which antidepressant will work best for an individual patient," and cautioned against changing a treatment that is already working. Prof Allan Young of the Royal College of Psychiatrists remarked that the observed advantages are modest and unlikely to outweigh personal factors such as side‑effects, past response and patient preference.

Like all medicines, escitalopram may cause sleep disturbances, constipation and weight gain, although not everyone experiences these effects. The NHS says that if escitalopram or a similar SSRI proves ineffective or unsuitable, doctors may recommend an alternative class such as an SNRI, while older tricyclics like amitriptyline are now prescribed less often. The mental health charity Mind said people need clear information about benefits and side‑effects as well as access to talking therapies and mindfulness, adding, "It's common for people to need to try more than one medication before they find the right treatment that works for them. And what works may change over time."