WebMD Medical News
Laura J. Martin, MD
Dec. 5, 2011 -- Newer antidepressants are all about equally effective, according to a new analysis, but that doesn't mean they work the same way for everyone.
"Contrary to drug industry claims, scientific evidence does not support the choice of one drug over another based solely on better effectiveness," says researcher Gerald Gartlehner, MD, MPH, a clinical epidemiologist at Danube University in Austria.
Gartlehner and his team analyzed studies that compared popular newer antidepressants such as Celexa (citalopram), Cymbalta (duloxetine), Prozac (fluoxetine), Wellbutrin (bupropion), Zoloft (sertraline), and others. They did find differences among the medicines for side effects such as sexual dysfunction and weight gain, and in how quickly the medications took effect.
The study is published in the Annals of Internal Medicine. It was funded by the Agency for Healthcare Research and Quality.
Most newer antidepressants prescribed to treat major depressive disorder are the so-called second-generation drugs. They work by affecting levels of brain chemicals such as serotonin or norepinephrine.
More than 16% of adults will be affected with major depressive disorder at some point, the researchers write.
Experts have debated which of the newer antidepressants are most effective. "Many individual studies have compared antidepressants for the treatment of depression," Gartlehner tells WebMD. "The results of the individual studies are mixed and sometimes contradictory, which can make it difficult for consumers to understand and interpret the results."
The researchers found 234 previously published, scientifically sound studies on antidepressants. They re-evaluated the results.
They looked at studies that compared two drugs to each other or a drug to a placebo. The majority of the studies, 77%, were funded by pharmaceutical companies. Some of the researchers also report consultant work for Novartis and for Takeda Pharmaceutical Company. Among the findings:
Side effects did differ. Overall, 63% of those on the medications had at least one negative effect. Most common:
There weren't enough data to draw conclusions about differences among the medications concerning some side effects, such as suicidal thoughts. The researchers say suicide is ''relatively rare" and affects one in 8,000 patients treated with the drugs. They agree with an FDA analysis that finds the risk increases in children and young adults but not in people older than age 24 who take the drugs.
In seven studies, Wellbutrin was linked with less sexual dysfunction than Lexapro (escitalopram), Paxil (paroxetine), Prozac, or Zoloft.
Remeron (mirtazapine) was associated with greater weight gain than Celexa, Paxil, Prozac, and Zoloft in seven studies.
"Mirtazapine in particular has a high risk for weight gain," Gartlehner says. However, he says, weight loss can accompany depression, so for some patients this could be an advantage.
Remeron worked faster than Celexa Paxil, Prozac, or Zoloft in seven studies.
Other second-generation antidepressants approved in the U.S. include Pristiq (desvenlafaxine), Luvox (fluvoxamine), Serzone (nefazodone), Desyrel (trazodone), and Effexor (venlafaxine).
Choosing an antidepressant should be done after a conversation between the doctor and the patient, Gartlehner says. They should consider side effects, costs, and other factors.
The new analysis is not surprising and echoes previous work, says Philip Muskin, MD, professor of clinical psychiatry at Columbia University and a member of the American Psychiatric Association.
Muskin reviewed the study findings for WebMD.
"I think the paper is very positive," he says. Of the second-generation drugs, he says, "They all work."
However, it's important to point out that no one drug works for everyone, he says: "So if one doesn't work, go to another."
Or if one works but causes side effects, he says it is important for the doctor and patient to talk about that and choose another.
Among patients prescribed antidepressants, he says, sexual problems and weight gain are at the top of the list of feared side effects.
SOURCES:Gartlehner, G. Annals of Internal Medicine, Dec. 6, 2011.Gerald Gartlehner, MD, MPH, clinical epidemiologist, Danube University, Austria.Philip Muskin, MD, professor of clinical psychiatry, Columbia University, New York; member, American Psychiatric Association.
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