ATLANTA— A comparison of antidepressants has found that two selective serotonin reuptake inhibitors (SSRIs), paroxetine and sertraline, were superior to a serotonin and norepinephrine reuptake inhibitor (SNRI), venlafaxine, in achieving and maintaining remission in patients with depression. The study was conducted to counter recent data from what lead author Suhayl J. Nasr, MD, believed were studies with follow-up periods too short to allow for typical responses such as relapse. “I wanted to compare the long-term effect of antidepressants to override the drug company marketing based on a few weeks’ or months’ observation,” explained Dr. Nasr.

“Initially, I just wanted to see how my patients were doing on which medication and for how long,” said Dr. Nasr, Adjunct Assistant Professor of Psychology at the University of Notre Dame in Indiana. He presented his findings at the 158th Annual Meeting of the American Psychiatric Association.

A chart review was conducted for all patients being seen in a private, rural, outpatient psychiatric office who had a current clinical diagnosis of unipolar depression. Patients completed the Carroll Depression Rating Scale at every visit. At their initial visit, patients had an average score of 15; a score greater than 10 denotes probable depression. Data collected also included patient demographics, medication history, and length of treatment.

Among the agents included in the study were venlafaxine, escitalopram, fluoxetine, bupropion, paroxetine, and sertraline. Dr. Nasr found that 322 patients with unipolar depression achieved remission at some point during their treatment on monotherapy. Patients were deemed to be in remission if they had a Carroll Depression Rating Scale score of 7 or lower.

SSRI SURPRISE

Patients experienced remission in an average of 4.5 months and had an average of one relapse during an average observation period of 4.5 years. The fastest remission, in an average of 0.24 years, was seen in patients on escitalopram monotherapy. Patients had the fewest relapses, 0.61, on sertraline monotherapy. Sertraline was superior to other antidepressants in achieving and maintaining remission in outpatients with depression.

“I was surprised to see that the SSRIs did better than the SNRI because all the recent hoopla has been about the dual action” of venlafaxine, Dr. Nasr told Neuropsychiatry Reviews. Although venlafaxine’s dual action had been suggested as a better option than the single action of SSRIs, Dr. Nasr’s observations found this to be valid only in the “first few weeks but not even the first six months” of treatment. Dr. Nasr did acknowledge that paroxetine and sertraline exert additional effects on norepinephrine and dopamine, respectively, making them more than just single-action drugs. It is his hope that “practicing physicians, as well as any physician involved in research, will look at the long-term benefits/risks of medications” and that comparison studies between the various antidepressants, mood stabilizers, and antipsychotics will be conducted.

—Heidi W. Moore

Suggested Reading
Burke WJ. Selective versus multi-transmitter antidepressants: are two mechanisms better than one? J Clin Psychiatry. 2004;65(suppl 4):37-45.
Carroll BJ, Feinberg M, Smouse PE, et al. The Carroll rating scale for depression. I. Development, reliability and validation. Br J Psychiatry. 1981;138:194-200.

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