The key facts

  • Escitalopram showed the best result for preventing relapse in an analysis of nearly 10,000 people who took the drugs for up to a year
  • It was followed by agomelatine and duloxetine, with fluoxetine (Prozac) slightly lower; sertraline and others showed no advantage
  • Specialists warn: the differences are modest, and those responding well to current treatment are not advised to switch medication

What the analysis showed

Published in The Lancet Psychiatry the analysis pooled previous studies of more than a dozen common antidepressants and covered almost 10,000 people who had taken the drugs for up to a year. Escitalopram performed best of all at preventing relapse — the return of depression symptoms. It was followed by agomelatine (an atypical antidepressant) and duloxetine (an SNRI), while fluoxetine, known as Prozac, ranked slightly below them.

How escitalopram differs from Prozac

Compared with fluoxetine, patients on escitalopram were more likely to achieve improvement in symptoms and to maintain it for longer, and were also less likely to stop taking the medication. Other drugs, including sertraline, showed no advantage. Escitalopram belongs to the SSRIs — selective serotonin reuptake inhibitors — which many medical guidelines name as first-choice drugs alongside sertraline and fluoxetine.

Why you shouldn't rush to change treatment

Experts stress that the differences identified are modest and do not mean that all patients with severe depression should switch to escitalopram. Professor Sameer Jauhar of Imperial College London noted that the study 'cannot say which antidepressant will work best for a particular patient', and does not consider it a reason to change treatment for those who respond well to their current drug. Professor Allan Young of the Royal College of Psychiatrists added that small advantages of some medicines are unlikely to outweigh individual factors — side effects, previous response to treatment and the patient's preferences.

Practical context

Depression is common: in the UK it affects roughly one person in six. To prevent relapse, doctors have previously recommended continuing antidepressants for at least six months after the depression has ended and then tapering them off gradually. Like any drug, escitalopram can cause side effects — sleep problems, constipation, weight gain — although not in everyone. According to the NHS, if escitalopram or a similar SSRI is ineffective or unsuitable, a doctor may offer a different type of antidepressant, such as an SNRI; older tricyclic drugs like amitriptyline are prescribed less often. The charity Mind notes that people often have to try several medicines before finding one that suits them, and calls for access to clear information about benefits, side effects and other forms of help, including talking therapy.

Limitations of the study

The authors and commentators agree that longer studies are needed for more complete conclusions. One of the study's authors, Professor Erik Rühé of Radboud University in the Netherlands, emphasised that the choice of drug is individual, but the results could help doctors and patients make joint decisions: choosing a medicine that not only helps recovery but also maintains remission.

A young woman sits on a sofa and holds a cold drink in one hand and a pill in the other. She is about to take her tablet.Image source, Getty Images
A young women with a stripey top holds a bottle of pills and reads the label.Lara is sitting on her bed with her legs tucked underneath her. She has long brown hair. She is wearing a pink cardigan and blue jeans. On the bed is a packet of antidepressants and a cardboard box.Henry Winchester sat on a bench. He has short dark hair and stubble. He is wearing a black coat and a brown jumper. He is sitting in front of a brown stone building with a path and grass.