Similar Effectiveness of Paroxetine, Fluoxetine, and Sertraline in Primary Care

Abstract

Selective serotonin reuptake inhibitors (SSRIs) have become the most commonly prescribed class of antidepressants, accounting for more than $3 billion of annual prescription costs in the United States and growing by approximately 25% each year.¹ Compared with tricyclic antidepressants, SSRIs have a more favorable adverse effect profile, simpler dosing, and less toxic effects in the event of an overdose.^2,3 Although each SSRI has demonstrated effectiveness, there are no clinical trial data supporting the superiority of one SSRI relative to another. Studies comparing SSRIs have had short follow-up periods, had a limited range of outcome measures, and have predominantly recruited participants from psychiatric inpatient settings.⁴ Thus, it would be important to compare the effectiveness of SSRIs using a broad range of clinically relevant outcomes (eg, social and work functioning, well-being, and other domains of health-related quality of life) that extends follow-up into the maintenance phase of treatment. Moreover, because most depression is treated in primary care, studies in this clinical venue are critical.⁵