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Update in Psychiatry
- Robert K. Schneider, MD; and
- James L. Levenson, MD
- From Medical College of Virginia Campus of Virginia Commonwealth University, Richmond, Virginia.
2002-2003 Series: Update Sessions from ACP–ASIM's 2002 Annual Session
David A. Cramer, MD, and Paul T. Kefalides, MD, Co-Editors
This is the third Update in Psychiatry since 1999 (1, 2). Combined with the Update in Addiction Medicine (3), these Updates represent a growing source of evidence-based information on psychiatry for general internists. This Update is broadly divided into the following categories: mood disorders, anxiety disorders, medical–psychiatric comorbid conditions, and cognitive disorders.
Mood (Affective) Disorders
Which Selective Serotonin Reuptake Inhibitor Works Best?
Selective serotonin reuptake inhibitors (SSRIs) are the most common class of antidepressants prescribed by primary care physicians in the United States. Despite the claims of pharmaceutical companies, it is not known whether one SSRI is more effective than another in the treatment of major depression.
Kroenke and colleagues conducted a randomized trial to compare the effectiveness of paroxetine (n = 189), fluoxetine (n = 193), and sertraline (n = 191) in patients whose primary care physician believed they should have antidepressant therapy for depression. The patients were enrolled from two large primary care research consortiums.
No statistical differences arose among the three SSRIs for any outcome measured. The percentage of patients who met diagnostic criteria for major depression decreased from 74% at baseline to 32% at 3 months and 26% at 9 months. Recovery rates did not differ among the three SSRIs: paroxetine, 81%; fluoxetine, 77%; and sertraline, 84%. The three groups contained similar percentages of patients who continued therapy with their initially assigned SSRI for 9 months: paroxetine, 41%; fluoxetine, 50%; and sertraline, 43%.
Nonpsychiatrists prescribe more than 75% of the SSRIs in the United States. Although trials have compared two SSRIs, no large-scale clinical trials have compared the three most frequently prescribed SSRIs. This study demonstrates equal effectiveness for treatment of depression among these three SSRIs used in a primary care setting for 9 months. …
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