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JAMA. 2001 Dec 19;286(23):2947-55.

Similar effectiveness of paroxetine, fluoxetine, and sertraline in primary care: a randomized trial.

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  • 1Regenstrief Institute for Health Care, Indianapolis, IN, USA. kkroenke@regenstrief.org

Abstract

CONTEXT:

Selective serotonin reuptake inhibitors (SSRIs) are the most commonly prescribed class of antidepressant, yet it is not known whether one SSRI is more effective than another.

OBJECTIVE:

To compare the effectiveness of 3 SSRIs (paroxetine, fluoxetine, and sertraline) in depressed primary care patients.

DESIGN:

Open-label, randomized, intention-to-treat trial, with patient enrollment occurring in April-November 1999.

SETTING:

Thirty-seven clinics in 2 US primary care research networks.

PATIENTS:

A total of 573 depressed adult patients for whom their primary care physician thought that antidepressant therapy was warranted and who completed a baseline interview.

INTERVENTIONS:

Patients were randomly assigned to receive paroxetine (n = 189), fluoxetine (n = 193), or sertraline (n = 191) for 9 months. Primary care physicians were allowed to switch patients to a different SSRI or non-SSRI antidepressant if they did not adequately respond to or tolerate the initial SSRI.

MAIN OUTCOME MEASURES:

The primary outcome measure was change in the Medical Outcomes Study 36-Item Short-Form Health Survey (SF-36) Mental Component Summary score (range, 0-100), compared across treatment groups at 1, 3, 6, and 9 months. Secondary outcomes included other depression and psychological measures, multiple measures of social and work functioning, and other domains of health-related quality of life, such as physical functioning, concentration and memory, vitality, bodily pain, sleep, and sexual functioning.

RESULTS:

Follow-up interviews were successfully completed in 94% of patients at 1 month, 87% at 3 months, 84% at 6 months, and 79% at 9 months. Responses to the 3 SSRIs were comparable on all measures and at all time points. The mean change in the SF-36 Mental Component Summary score at 9 months was + 15.8 in the paroxetine group, + 15.1 in the fluoxetine group, and + 17.4 in the sertraline group. The drugs were also associated with similar incidences of adverse effects and discontinuation rates.

CONCLUSIONS:

The SSRI antidepressants paroxetine, fluoxetine, and sertraline were similar in effectiveness for depressive symptoms as well as multiple domains of health-related quality of life over the entire 9 months of this trial.

PMID:
11743835
[PubMed - indexed for MEDLINE]
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