Clinical Review

When starting an antidepressant, try either of these 2 drugs first

OBG Manag. 2009 November;21(11):30-39

References

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Most of the included studies were sponsored by drug companies. Notably, pharmaceutical companies have the option of continuing to conduct trials of medications until a study results in a positive finding for their medication, with no penalty for the suppression of equivocal or negative results (negative publication bias). Under current FDA guidelines, there is little transparency for the consumer as to how many trials have been undertaken and the direction of the results, published or unpublished.¹⁴

We doubt that either publication bias or the design and sponsorship of the studies included in this meta-analysis present significant threats to the validity of these findings over other sources upon which guidelines rely, given that these issues are common to much of the research on pharmacotherapy. We also doubt that the compensation of the authors by pharmaceutical companies would bias the outcome of the study, in this instance. One of the authors (Furukawa) received compensation from Pfizer, the maker of Zoloft, which is also available as generic sertraline. None of the authors received compensation from Forest Pharmaceuticals, the maker of Lexapro (escitalopram).

No major barriers anticipated

Both sertraline and escitalopram are covered by most health insurers. As noted, sertraline is available in a generic formulation and is therefore much less expensive than escitalopram.

In a review of drug prices at www.pharmacychecker.com, we found that a prescription for a 3-month supply of Lexapro (10 mg) costs about $250. A 3-month supply of generic sertraline (100 mg) from the same sources costs approximately $35. Pfizer, maker of Zoloft, and Forest Pharmaceuticals, maker of Lexapro, both administer patient assistance programs to make these medications available to low-income, uninsured patients.

WHAT THIS EVIDENCE MEANS FOR PRACTICE

When you initiate an antidepressant for a patient who has not been treated for depression in the past, select either sertraline (Zoloft) or escitalopram (Lexapro).

Acknowledgment

Sofia Medvedev, PhD, of the University HealthSystem Consortium, Oak Brook, Ill., analyzed data from the National Ambulatory Medical Care Survey and the UHC Clinical Database as part of the development of the manuscript of this article.