Escitalopram and Duloxetine Rank Ahead for Lasting Depression Relief

Researchers compared antidepressants in 115 clinical trials, evaluating both patients’ recovery from depression and whether that recovery lasted. The studies lasted from 12 weeks to two years, and fluoxetine, sold as Prozac, served as the benchmark for comparisons.

Escitalopram, also known as Lexapro or Cipralex, had 62% higher odds of sustained recovery than Prozac. Duloxetine, marketed as Cymbalta, had 57% higher odds, while agomelatine had 40% higher odds. The analysis also found citalopram and sertraline performed better than Prozac, though the evidence was insufficient to establish that their advantage was genuine.

Clomipramine initially appeared to lead the rankings, with 117% higher odds than Prozac. But that result came from a single trial involving only 32 people, so it was not considered reliable. Venlafaxine, reboxetine and bupropion showed lower odds of sustained recovery than Prozac; bupropion ranked lowest among the drugs in the analysis.

The researchers said the findings could help inform treatment choices, particularly for people starting medication. They also stressed that a drug’s benefits must be weighed against its side effects, and that the best option can differ between patients. Some people stop taking antidepressants because of effects including fatigue, weight changes, sleep disruption and sexual dysfunction. People who have found a treatment that works may have less reason to switch, one study author said.