Research by Radbound University Medical Center analyzing 21 antidepressants showed that escitalopram, agomelatine, and duloxetine are the most effective over the long term. They were found to be outperforming fluoxetine, the active ingredient of the well-known drug Prozac.
The three drugs ranked highest for lasting recovery and lower chance of relapse. The finding partially conflicted with current Dutch guidelines, which recommend citalopram, escitalopram, sertraline, and fluoxetine as preferred choices.
The analysis reviewed 115 earlier studies that together included more than 30,000 participants. Researchers compared the drugs on short-term results after four to eight weeks and on longer-term outcomes after six to 12 months. About 1.2 million people in the Netherlands take antidepressants; roughly half a million have stayed on the same medication for more than two years, and about 300,000 people begin treatment each year.
“We collected all the research on the effectiveness of antidepressants,” first author Paul van Haaren told RTL. “The main question is, if someone comes into the consulting room with depression for the first time, which antidepressant gives the greatest chance that the person both recovers and does not relapse?”
The researcher called the difference between escitalopram and fluoxetine notable. “Fluoxetine is still effective, but the chance is greater that someone recovers faster and more long-lasting.” When the two were compared, co-researcher Eric Ruhé said, “If you treat eight people with antidepressants, one additional person improves because of escitalopram.”
The finding applies to people starting medication and does not mean patients already doing well should switch. Personal factors, such as tolerance of sexual side effects or risk of weight gain, still matter. “Or maybe you have confidence in a certain medication because your brother improved on it. It is always something to consider together,” Ruhé said.