Antidepressant rankings: Zoloft and Lexapro considered best overall

A number of antidepressants were recently ranked in different surveys:

Zoloft and Lexapro came in first for a combination of effectiveness and fewer side effects, followed by Prozac (fluoxetine), Paxil (paroxetine), Cymbalta, and Luvox among others.

The first was efficacy — or how likely patients were to experience the desired effects of the drug.

Efficacy:

1. Remeron (Mirtazapine)
2. Lexapro (Escitalopram)
3. Effexor (Venlafaxine)
4. Zoloft (Sertraline)
5. Celexa (Citalopram)
6. Wellbutrin (Buproprion)
7. Paxil (Paroxetine)
8. Savella (Milnacipran)
9. Prozac (Fluoxetine)
10. Cymbalta (Duloxetine)
11. Luvox (Fluvoxamine)
12. Vestra (Reboxetine)

The second was acceptability — the likelihood that a patient would continue using a drug for the duration of the study (it is generally assumed that a high ratio of patients dropping out indicates the presence of undesirable side effects for a drug).

Acceptability:

1. Zoloft (Sertraline)
2. Lexapro (Escitalopram)
3. Wellbutrin (Buproprion)
4. Celexa (Citalopram)
5. Prozac (Fluoxetine)
6. Savella (Milnacipran)
7.
Remeron (Mirtazapine)
8. Effexor (Venlafaxine)
9. Paxil (Paroxetine)
10. Cymbalta (Duloxetine)
11. Luvox (Fluvoxamine)
12. Vestra (Reboxetine)

antidepressantsMy experience with Lexapro was a disaster and I’ve written about Zoloft’s connection with irritability and rage. Paxil’s side effects are especially rough (see Bob Fiddaman’s Seroxat page) while Effexor’s withdrawal effects proved to be significantly challgenging. Although Prozac offset Effexor’s withdrawal symptoms, it causes severe somnolence that can impair cognitive functioning. And last but not least, Cymbalta contributed to the unfortunate death of Traci Johnson who had no history of depression.

These drugs may be effective for many people but it’s still a guessing game. Dr. Mark I. Levy, quoted in ABC News’s article on the rankings, mentioned that while psychiatrists may not have much use for the rankings, he sees them as beneficial for primary care physicians. And Dr. Harold G. Koenig, a professor at Duke University Medical Center, adds:

“I would be likely to start patients on either Zoloft [because it’s cheaper] or Lexapro … Unfortunately, that is almost none of my patients. By the time they get to me [a psychiatrist], the primary-care doctors have tried Zoloft and other antidepressants, so my patient are not the “new to medication” kind of patients,” he said.

I won’t rehash my thoughts on PCPs prescribing antidepressants and other psych meds. You can read about them here.

Thank you

Thank you, everyone, for your well-wishes and outpouring of support. I saw my psych today and he is adding 2-5 mg of Abilify to my medication regimen. He had me choose between Geodon and Abilify. Of course, I am hesitant to do this. Take a look at Philip’s post on Abilify and then take a look at CLPsych’s post about how Abilify performed against placebo. My psych pointed out that I did better on 200 mg of Lamictal but I distinctly remember feeling cognitive impairment on 200. The 150 seemed to work well for a while but I don’t know what’s happening. And to be quite honest, I’m always a little wary of alternative treatments even though I know they have helped so many people. I wonder if they are for me.

More thoughts soon…

Cognitive functioning

Lately, my cognitive functioning has been absolute CRAP. My thoughts feel slow and dulled. I find myself constantly at a loss for words, especially verbally, which hinders my communication skills. I think this is not only affecting my job performance, but also my social skills on the job. This is probably why I’m making so many mistakes and forgetting things to do despite my endless lists. As a result, I’m worried about applying for a new job and feeling incredibly slow and dull like I do now. I wonder if it is the Lamictal or something else. I didn’t feel this way before I got bumped up to 200 mg, but the problem is quite apparent right now. I’ve become a whiz at solving sudoku puzzles (especially the hard ones!), but now, I’m lucky if I can solve medium. Easy takes me quite a while to finish now. If it is the Lamictal, my husband and I have discussed a trade-off: mixed episodes or the return of cognitive functioning? It’s like choosing between psychotic episodes or obesity. What would your choice be?

I apologize in advance for misspellings or sentences that don’t make sense. In some ways, I miss my pre-200 mg Lamictal self.