Popularity doesn't necessarily make Prozac best antidepressant choice

Although Prozac has achieved phenomenal marketing success, it may not be as effective as certain other antidepressants, according to a recent systematic review.

Researchers led by Andrea Cipriani, M.D., compared Prozac (fluoxetine) to other selective serotonin reuptake inhibitors, and to other antidepressants and found that Zoloft (sertraline) and Effexor (venlafaxine) were somewhat better for treating depression.

The review also compared the tolerability of fluoxetine and several other often-prescribed antidepressants. Patients found fluoxetine more tolerable than both Elavil or Endep (amitryptilline) and Tofranil (imipramine).

Cipriani, a psychiatrist at the University of Verona in Italy, said in an e-mail, "Fluoxetine, the most widely studied SSRI, has progressively replaced amitriptyline and imipramine as the standard of comparison for newer medications. We chose fluoxetine because of its long-time position as the market leader and because it has been often used as a reference compound for newer [antidepressants]."

Psychiatrist Xavier Amador, a member of the board of directors for the National Alliance for the Mentally Ill, said, "Prozac was available years before other SSRIs. Since, as a group, the SSRIs were far safer than [earlier antidepressants] the first one, Prozac, became hugely popular. It has tremendous name recognition for this reason."

The review appeared in the latest issue of the Cochrane Library. The Cochrane Library is a publication of The Cochrane Collaboration, an independent international organization that evaluates medical research. Systematic reviews draw evidence-based conclusions about medical practice after considering both the content and quality of existing medical trials on a topic.

The review pooled data from 132 published randomized controlled trials, with effectiveness data on 9,311 participants and of tolerability data on 14,391 participants, both inpatients and outpatients diagnosed

Contact: Andrea Cipriani
Center for the Advancement of Health

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