Escitalopram Tops Antidepressant Ranking for Preventing Depression Relapse, Large Analysis Finds

A large new analysis has put one antidepressant at the top of a list that matters to anyone who has recovered from depression and wants to stay well: escitalopram. The study, published in The Lancet Psychiatry, drew on nearly 10,000 people who had been prescribed different medications for up to a year, and it measured how well each drug kept symptoms from coming back.

Escitalopram performed best at preventing relapse. Two other pills, agomelatine and duloxetine, came next, with Prozac, also known as fluoxetine, ranking just below them. The researchers did not run a new trial. They pooled previous studies that compared the effectiveness of more than a dozen common antidepressants.

Set against Prozac, the findings were fairly specific. People taking escitalopram were more likely to see their symptoms improve and stay improved, and less likely to stop taking the medication. Agomelatine, an atypical antidepressant, and duloxetine, which belongs to the class known as SNRIs (selective noradrenaline reuptake inhibitors), also did well. Other medicines, including sertraline, were no better than Prozac.

Escitalopram is an SSRI, a class that many medical guidelines recommend as the first drug of choice, alongside sertraline and fluoxetine. These drugs raise levels of serotonin, which is linked to mood. Like all medicines, escitalopram can cause side effects, including sleep problems, constipation and weight gain, though not everyone experiences them.

The stakes are real. Depression affects around one in six people in the UK, and while many make a good recovery with the right treatment and support, for some it returns. To guard against that, doctors already advise staying on antidepressants for at least six months after depression ends, then tapering off gradually.

One of the researchers, Prof Eric Ruhé of Radboud University in the Netherlands, said the best choice of medication varies from person to person. Even so, he said, the study can inform decisions that prescribers and patients make together: if you start an antidepressant, choose one that not only helps you get well but also keeps you well.

Outside experts were careful about how far the result should travel. Dr Sameer Jauhar of Imperial College London said the research was useful but cannot say which antidepressant will work best for an individual patient, and he would not read it as a reason for someone doing well on their current drug to switch. Prof Allan Young of the Royal College of Psychiatrists said some medicines appear to have a small advantage for longer-term outcomes, but the differences are modest and unlikely to outweigh side effects, previous response and patient preference. The differences found were modest, and experts say longer studies are still needed.

The NHS says that if escitalopram or a similar SSRI is ineffective or unsuitable, doctors may suggest a different type, such as an SNRI. Older tricyclic drugs like amitriptyline are now prescribed less often. The charity Mind says people need clear information on the benefits and side effects of antidepressants, plus other support such as talking therapies and mindfulness. It notes that many people try more than one medication before finding one that works, and that what works may change over time. Anyone weighing their options is advised to talk with their doctor, and Mind's website has information comparing different antidepressants.