Escitalopram performed best at preventing depression from returning, according to a major new analysis of antidepressants published in The Lancet Psychiatry.

The analysis drew together 115 randomised trials involving more than 30,000 participants and compared 20 antidepressants with one another. Reporting on the findings, the BBC said escitalopram came out on top for preventing relapse in a group of nearly 10,000 people who were prescribed different medicines for up to a year.

Two other medicines — agomelatine and duloxetine — came next in the rankings, while fluoxetine, widely known as Prozac, ranked just below them. Compared with fluoxetine, people taking escitalopram were more likely to see their symptoms improve and stay improved, and less likely to stop taking their medicine altogether.

What the researchers found

The study is the first large-scale comparison of antidepressants for both short-term and long-term use. Its authors say the results should inform the first choice of antidepressant, because many people stay on the medicine after they recover in order to prevent a relapse.

“Escitalopram is already widely used,” said first author Paul van Haaren. He added that agomelatine works well but carries a risk of liver failure as a side effect, while duloxetine is less well known and is prescribed less frequently as a first-line treatment.

One of the researchers, Professor Eric Ruhé of Radboud University in the Netherlands, said the choice of medicine can vary for each individual. “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,” he said.

Experts urge caution over switching

Experts were quick to stress that the differences found between the drugs were modest, and that longer studies are still needed. They said the findings do not mean that everyone with severe depression should switch to escitalopram, or that other antidepressants are not any good, because all of the drugs can work and each has its pros and cons.

Dr Sameer Jauhar, a psychiatrist at Imperial College London, cautioned that the analysis “cannot tell us which antidepressant will work best for an individual patient”. He added: “I would not interpret these findings as a reason for someone who is responding well to their current antidepressant to change treatment.”

Professor Allan Young, of the Royal College of Psychiatrists, similarly stressed that the differences were modest and were unlikely to outweigh individual factors such as side effects, previous response and patient preference when deciding on treatment.

How long should treatment continue?

Doctors already recommend that people stay on antidepressants for at least six months after depression ends, and then reduce the dose gradually rather than stopping suddenly.

Depression affects about one in six people in the United Kingdom. The mental health charity Mind publishes information to help people compare different antidepressants, and patients are encouraged to discuss treatment choices thoroughly with their GP or prescriber. Anyone taking an antidepressant should not stop or change their medicine without speaking to their doctor first.

Sources: The UK Pulse and Medical Xpress. The study is published in The Lancet Psychiatry (DOI: 10.1016/S2215-0366(26)00326-3).