Newer Antidepressants Work Equally Well, Study Finds
But Medicines Do Differ in Side Effects, How Quickly They Work
Newer Antidepressants: Differences
Side effects did differ. Overall, 63% of those on the medications had at least one negative effect. Most common:
- Weight gain
- Sexual problems
- Dry mouth
There weren't enough data to draw conclusions about differences among the medications concerning some side effects, such as suicidal thoughts. The researchers say suicide is ''relatively rare" and affects one in 8,000 patients treated with the drugs. They agree with an FDA analysis that finds the risk increases in children and young adults but not in people older than age 24 who take the drugs.
In seven studies, Wellbutrin was linked with less sexual dysfunction than Lexapro (escitalopram), Paxil (paroxetine), Prozac, or Zoloft.
Remeron (mirtazapine) was associated with greater weight gain than Celexa, Paxil, Prozac, and Zoloft in seven studies.
"Mirtazapine in particular has a high risk for weight gain," Gartlehner says. However, he says, weight loss can accompany depression, so for some patients this could be an advantage.
Remeron worked faster than Celexa Paxil, Prozac, or Zoloft in seven studies.
Other second-generation antidepressants approved in the U.S. include Pristiq (desvenlafaxine), Luvox (fluvoxamine), Serzone (nefazodone), Desyrel (trazodone), and Effexor (venlafaxine).
Choosing an antidepressant should be done after a conversation between the doctor and the patient, Gartlehner says. They should consider side effects, costs, and other factors.
Newer Antidepressants: Perspective
The new analysis is not surprising and echoes previous work, says Philip Muskin, MD, professor of clinical psychiatry at Columbia University and a member of the American Psychiatric Association.
Muskin reviewed the study findings for WebMD.
"I think the paper is very positive," he says. Of the second-generation drugs, he says, "They all work."
However, it's important to point out that no one drug works for everyone, he says: "So if one doesn't work, go to another."
Or if one works but causes side effects, he says it is important for the doctor and patient to talk about that and choose another.
Among patients prescribed antidepressants, he says, sexual problems and weight gain are at the top of the list of feared side effects.