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The Italian researchers reviewed 117 studies that included more than 25,000 patients with major depression to come to this conclusion.
The drugs tested in the trials were bupropion (Wellbutrin/Zyban), citalopram (Celexa), duloxetine (Cymbalta), escitalopram, fluoxetine (Prozac), fluvoxamine (Luvox), milnacipran (Savella), mirtazapine (Remeron), paroxetine (Paxil), reboxetine (Edronax/Vestra), sertraline, and venlafaxine (Effexor).
Based on their analysis, the review authors concluded sertraline and escitalopram were the best antidepressants overall in terms of efficacy and patient acceptability. Sertraline was found to be more effective than duloxetine by 30%, fluvoxamine (27%), fluoxetine (25%), paroxetine (25%), and reboxetine (85%). Escitalopram was more effective than duloxetine by 33%, fluoxetine (32%), fluvoxamine (35%), paroxetine (30%), and reboxetine (95%).
Mirtzapine and venlafaxine were as effective as sertraline and escitalopram. But the latter two drugs had the best patient acceptability, which meant significantly fewer patients stopped treatment.
The review was published online Jan. 29 and was expected to be published in an upcoming print issue of The Lancet.
"The most important clinical implication of the results is that escitalopram and sertraline might be the best choice when starting a treatment for moderate to severe major depression, because they have the best possible balance between efficacy and acceptability," Dr. Andrea Cipriani, of the University of Verona in Italy, and colleagues said in a news release from the journal.
"Sertraline seems to be better than escitalopram because of its lower cost in most countries. However, in the absence of a full economic model, this recommendation cannot be made unequivocally, because several other costs are associated with the use of antidepressants," they added.
-- Robert Preidt
SOURCE: The Lancet, news release, Jan. 29, 2009
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