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Three SSRIs Are Equally Effective

Primary care physicians must choose among several selective serotonin reuptake inhibitors (SSRIs) as first-line therapy for depression. In this multisite, industry-sponsored, randomized trial, 537 primary care patients (mean age, 46) with clinical depression received fluoxetine, paroxetine, or sertraline. Treatment assignment was not blinded, physicians were free to make changes in dosage or medication, and, except for reasons of patient safety, study assessments made during phone interviews with patients were not available to treating physicians. Approximately 45% of patients continued taking initially assigned medications through 9 months.

At 3 and 9 months, there was no significant difference among the 3 groups in a wide range of depression and functional outcome assessments, with clinically significant improvements in roughly 70% to 80% of all patients at 9 months. Intent-to-treat and various subgroup analyses also showed similar outcomes associated with the 3 medications, and similar magnitudes of response. Side effects that resulted in stopping or switching medications were similar for all 3 drugs and were relatively infrequent.

Comment: This study is important because it involved primary care patients and reflected typical primary care practices. According to an editorialist, the results support formulary restrictions for first-line SSRI selection because there were no significant differences among the 3 drugs, but they also support no restrictions for second- or third-line drug choice because of the 55% rate of switching or stopping drugs during the study.

— Thomas L. Schwenk, MD

Published in Journal Watch General Medicine January 11, 2002

Citation(s):

Kroenke K et al. Similar effectiveness of paroxetine, fluoxetine, and sertraline in primary care: A randomized trial. JAMA 2001 Dec 19; 286:2947-55.

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• Medline abstract (Free)

Simon G. Choosing a first-line antidepressant: Equal on average does not mean equal for everyone. JAMA 2001 Dec 19; 286:3003-4.

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• Medline abstract (Free)