Zoloft, Lexapro the Best of Newer Antidepressants

THURSDAY, Jan. 29 (HealthDay News) -- Sertraline (Zoloft) and escitalopram (Lexapro) are the best of 12 new-generation antidepressants, while reboxetine is the least effective, a new analysis shows.

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 percent, fluvoxamine (27 percent), fluoxetine (25 percent), paroxetine (25 percent), and reboxetine (85 percent). Escitalopram was more effective than duloxetine by 33 percent, fluoxetine (32 percent), fluvoxamine (35 percent), paroxetine (30 percent), and reboxetine (95 percent).

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.

More information
The U.S. Agency for Healthcare Research and Quality has more about antidepressants.

Antidepressants: Know Your Options

About 2 dozen antidepressant medications are approved by the FDA for use in the U.S. Some date back to the 1950s, while others have been released in the past few years. Some are like siblings, with very similar chemical characteristics, while others are more like distant cousins with very different pharmacologic properties. Some of the shorter-acting medications are available in extended-release pill formulations that release the drug over a longer period of time. All of the antidepressants are available in tablet or capsule form, a few are made in liquid preparations, and one is available as a patch.

Antidepressants affect neurotransmitters in the brain that are believed to be involved in the regulation of mood, although exactly how and why they work is not fully understood. The two key neurotransmitters influenced by antidepressants are norepinephrine and serotonin, although some affect dopamine. Antidepressants may block the reuptake of these neurotransmitters or interact with neurotransmitter receptors at synapses within the brain.

The earliest antidepressants were the tricyclic compounds (TCA), named for their chemical structure, and the monoamine oxidase inhibitors (MAOIs). The MAOIs act by interfering with the action of monoamine oxidase, an enzyme that ordinarily breaks down the beneficial neurotransmitters such as serotonin and norepinephrine. By slowing this breakdown, MAOI allows the neurotransmitters to remain active longer. While both these early classes of drugs are effective antidepressants, the TCAs and MAOIs are both associated with bothersome side effects, sometime serious ones.

New types of antidepressants rapidly became available in the 1980s, especially with the popularity of the selective serotonin receptor inhibitors (SSRI) like Prozac. Over the past few decades, selective serotonin and norepinephrine reuptake inhibitors (SNRI), serotonin modulating antidepressants (SMA), a dopamine and norepinephrine reuptake inhibitor (DNRI), a tetracyclic antidepressant, a newer type of MAOI, and a norepinephrine and selective serotonergic antidepressant (NaSSA) were approved and marketed. All have certain advantages and disadvantages.

Here is a list of the antidepressants currently available in the U.S. I've listed the generic names along with the primary brand name, and the antidepressant type of each:

Generic Name	Brand Name	Type
Amitriptyline	Elavil®	TCA
Bupropion	Wellbutrin®	DNRI
Citalopram	Celexa®	SSRI
Clomipramine	Anafranil®	TCA
Desipramine	Nopramin®	TCA
Doxepin	Sinequan®	TCA
Duloxetine	Cymbalta®	SNRI
Escitalopram	Lexapro®	SSRI
Fluoxetine	Prozac®	SSRI
Fluvoxamine	Luvox®	SSRI
Imipramine	Tofranil®	TCA
Isocarboxacid	Marplan®	MAOI
Maprotiline	Ludiomil®	Tetracyclic
Mirtazapine	Remeron®	NaSSA
Nortriptyline	Pamelor®	TCA
Paroxetine	Paxil®	SSRI
Phenelzine	Nardil®	MAOI
Protriptyline	Vivactyl®	TCA
Selegiline	Emsam®	MAOI
Sertraline	Zoloft®	SSRI
Tranylcypromine	Parnate®	MAOI
Trazodone	Desyrel®	SMA
Trimipramine	Surmontil®	TCA
Venlafaxine	Effexor®	SNRI