Are all antidepressants alike?

Are all antidepressants alike? That's the question on the minds of many patients and clinician's following the release of a new clinical practice guideline by the American College of Physicians published in the latest issue of the Annals of Internal Medicine.

The authors of the guideline looked at second-generation antidepressants--reviewing more than 200 studies--and found no significant differences in efficacy. The medications reviewed were bupropion, citalopram, duloxetine, escitalopram, fluoxetine, fluvoxamine, mirtazapine, nefazodone, paroxetine, sertraline, trazadone and venlafaxine. 

The authors did find differences in adverse effects, however. Lead author, Dr. Amir Qaseem, a senior medical associate in ACP's Clinical Programs and Quality of Care Department, said the drugs are "equally effective for treating depression." He also said that the "ACP recommends that physicians make treatment decisions based on side effects, cost and patient preferences, and make necessary changes in therapy if the response is not sufficient after six to eight weeks."

Second generation medications generally are considered effective for the approximately 16 percent of individuals who suffer from depression, and many say the newer drugs have fewer side effects than older formulations, such as tricyclic antidepressants. Still, when it comes to efficacy and quality of life, the medications are pretty much the same, the reviewers said, despite the millions of dollars spent by drugmakers trying to differentiate them from each other.

Nonetheless, while there wasn't a single drug with an increased risk of suicide according to the review, patients receiving SSRIs had an increased risk for nonfatal suicide attempts. Other concerns about the review include possible ties of some of the reviewers to manufacturers of the medications under review.  

- see the story in the US News & World Report
- find the LA Times version
- read the Pharmalot blog post