mind & bodyanalysisThe Conversation (Australia)

Some antidepressants may work better than others long term – new study

the gist

A review of 115 randomised trials involving more than 30,000 people compared how well different antidepressants keep depression symptoms improved over six months or longer. Three drugs, escitalopram (Lexapro), duloxetine (Cymbalta) and agomelatine, were more likely than fluoxetine (Prozac) to be linked with a sustained response, and people on escitalopram or duloxetine were also less likely to stop taking them. The result is far from definitive: more than half the trials in the main analysis had a high risk of bias, and some drugs had very few studies behind them. Clinical guidelines suggest continuing treatment for at least six to 12 months after a good response, and stopping gradually with medical advice.

how it works

Researchers pool results from many trials with a statistical method that compares drugs indirectly through shared comparators, then measure sustained response and the share of people who drop out, which acts as a proxy for how tolerable a drug is.

so what

Depression treatment is not one-size-fits-all, and comparisons like this help doctors weigh options. But differences found in studies with limited quality may reflect research limits rather than real differences between the drugs, so decisions should be made with a doctor.

fun fact

Fluoxetine, sold as Prozac, was approved in the US in 1987 and was one of the first widely used SSRIs.

more on this

background

Antidepressants, also known in the past as psychic energizers, are a class of medications used to treat major depressive disorder, anxiety disorders, chronic pain, and addiction.

Common side effects of antidepressants include dry mouth, weight gain, dizziness, headaches, akathisia, sexual dysfunction, and emotional blunting. There is an increased risk of suicidal thinking and behavior when taken by children, adolescents, and young adults. Discontinuation syndrome, which resembles recurrent depression in the case of the SSRI class, may occur after stopping the intake of any antidepressant, having effects which may be permanent and irreversible. Tapering off medications gradually is shown to reduce the risk of withdrawal complications.

From Wikipedia: Antidepressant (CC BY-SA 4.0) ↗ · text CC BY-SA 4.0

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Illustrative photo · Avopasia, CC BY-SA 4.0, via Wikimedia Commons