When it comes to antidepressants – Zoloft and Lexapro were the best of the newer drugs.
That is the conclusion of Italian researchers who reviewed 117 studies and the records of more than 25,000 patients with major depression. Their review is scheduled to be published in the British medical journal, The Lancet.
Choosing a treatment option has been largely an educated guess with the patient at the receiving line of medications that often are ineffective. That can lead to a series of mixed results. These psychiatrists wanted to bring some guidance to doctors and patients.
Depression drugs include:
- Zoloft (sertraline)
- Lexapro (escitalopram)
- Wellbutrin/ Zyban (bupropion)
- Celexa (citalopram)
- Cymbalta (duloxetine)
- Prozac (escitalopram, fluoxetine)
- Luvox (fluvoxamine)
- Savella (milnacipran)
- Remeron (mirtazapine)
- Paxil (paroxetine)
- Edronax/Vestra (reboxetine)
- Effexor (venlafaxine)
Zoloft and Lexapro were found by the authors to be the most effective and had the widest patient acceptability, meaning fewer patients stop treatment. Remeron and Effexor also ranked high in patient acceptability.
The authors conclude that Zoloft and Lexapro might be the best first choice for treatment of severe depression.
However, Dr. Mark Levy, a psychiatrist at the University of San Francisco says the top ten list won’t change the way he prescribes.
He tells ABC News he finds Zoloft and Lexapro have fewer side effects such as agitation, insomnia or weight gain, but he tries to match a patients’ emotional profile to a drug.
"For example, an agitation patient with severe insomnia may do best on Paxil, not Zoloft ... a patient with marked symptoms of psychomotor retardation may do best on Prozac. A patient with great concern about their libido may do best starting on Wellbutrin," Levy said.
Levy says the list might be most useful to a family physician who is not a psychiatrist, yet who is often first to prescribe an antidepressant.
Patients Open Up About Mental Illness
ABC News featured patients who chose to come forward to talk about their struggles with major depression and bipolar disorder, coming from a point where it seemed impossible they would come back.
Mary Ann Ceron says she felt suicidal at the age of 15, but her mother didn’t help her. Her mother was undiagnosed with depression, she says. “It’s really hard, I couldn’t make it to work, it was just a sleep that overcame me, I didn’t have any energy. I was at some point catatonic.”
Eric Arauz says his father tried to end his life in a parking lot when he was 12. Arauz later ended up in a maximum security mental institution in four-point restraints, diagnosed with bipolar disorder.
“My mental illness had taken me to a point where there seemed no point to come back.”
Psychiatrist Dr. Melva Green says women experience depression twice as much as men, but are more likely to ask for help.
“But interestingly enough, men are twice as likely as women to commit suicide. They may not say they are sad or blue, they may have agitation or anger, but essentially it’s an episode of depression.”
Both Ceron and Arauz are patient advocates with the National Alliance for Mental Illness (NAMI), a grassroots national organization for people with mental illness and their families. They both feel there is a lot of reason to be encouraged.
Ceron tells Dr. Atkinson when she felt suicidal, she was reminded that her children were a reason she wanted to live.
Arauz says, “Please don’t give up, please don’t think you are alone, don’t make a decision that is permanent for something that is temporary. You can reach out and find help, help is there.” #