Escitalopram came out on top in a large analysis of how well antidepressants keep patients free of depression symptoms, the BBC reported. The drug performed best at preventing relapse in a study involving nearly 10,000 people who were prescribed different medications for up to a year. Agomelatine and duloxetine came next, while fluoxetine, also known as Prozac, ranked just below them. Experts stressed that the findings do not mean everyone with severe depression should switch to escitalopram, or that other antidepressants do not work, because all the drugs can help and each has pros and cons. The analysis was published in The Lancet Psychiatry. The differences were modest, and researchers say longer studies are still needed.

Depression affects around one in six people in the UK. With the right treatment, many recover, though symptoms can return. Doctors already recommend that people stay on antidepressants for at least six months after a depressive episode ends, then taper gradually. The new paper reviewed previous studies comparing more than a dozen common antidepressants. There are many causes of depression and several treatments, including talking therapies, and experts say patients should discuss options with their doctor. Many guidelines recommend SSRI antidepressants, such as escitalopram, sertraline, and fluoxetine, as a first drug choice. Those medicines increase serotonin, which is linked to mood.

Compared with fluoxetine, people on escitalopram were more likely to see their symptoms improve and stay that way, and less likely to stop taking their medication, the analysis found. Agomelatine, an atypical antidepressant, and duloxetine, an SNRI, also performed well. Some other medicines, including sertraline, were no better than fluoxetine on the measures used. Prof. Eric Ruhé of Radboud University Medical Center in the Netherlands, one of the researchers, said medication choice varies by person. "Nevertheless, our study can help inform the decisions that prescribers and patients make together: if you start an antidepressant, choose one that not only helps you to get well, but also keeps you well."

Dr. Sameer Jauhar of Imperial College London said the work "cannot tell us which antidepressant will work best for an individual patient" and should not be a reason for someone who is doing well to switch. Prof. Allan Young of the Royal College of Psychiatrists said any small advantage was "unlikely to outweigh individual factors such as side effects, previous response and patient preference." Like all medicines, escitalopram can cause side effects, including sleep problems, constipation, and weight gain, though not everyone has them. The verified result is a modest ranking in a large evidence review, not a new prescription rule.