REVEALED: The ‘best’ antidepressant for long-term recovery – and it’s NOT sertraline or Prozac. Plus, our psychiatrist’s guide to which drug could work best for you

The antidepressants that offer patients the best chance of beating depression – and staying well in the long term – have been revealed in a major study.

Researchers ranked 20 of the most widely used medications to discover which were most likely to help patients recover fully, rather than simply ease their symptoms.

And they found striking differences between some of the most popular drugs, with one outperforming both Prozac and sertraline – the most commonly prescribed antidepressant in Britain.

The findings could have major implications for the millions taking the medications, helping doctors choose treatments that are most likely to keep depression at bay.

Researchers in the Netherlands analysed more than 115 clinical trials involving over 30,000 patients, comparing how well different antidepressants worked and whether patients remained well over time.

Escitalopram, sold under the brand names Lexapro and Cipralex, emerged as the strongest performer among drugs with substantial supporting evidence.

At the other end of the rankings was bupropion, also marketed as Wellbutrin or Zyban, which performed worst of the 20 drugs studied. 

Experts say the findings, published in The Lancet Psychiatry, could help doctors choose treatments that ‘not only help you to get well, but also keep you well’.

The research comes amid soaring antidepressant use in Britain, with a record one in seven people in England now taking the medications.

Figures also suggest that around 16 per cent of adults experience symptoms of depression or anxiety in any given week.

While some patients take antidepressants for just a few months, others remain on them for years, often because their symptoms return when they try to stop.

More than a quarter of patients taking antidepressants in England have been on the drugs for at least five years, according to NHS figures.

To establish which treatments offer the best chance of lasting recovery, researchers at Radboud University Medical Centre in the Netherlands compared 20 antidepressants against fluoxetine, better known as Prozac.

They examined not only whether patients recovered from depression, but also whether they remained well over time without suffering a relapse.

One drug, clomipramine, initially appeared to be the clear winner, with patients having 117 per cent higher odds of recovering and remaining well than those taking Prozac.

However, the finding was based on just 32 patients in a single trial, making it too unreliable to draw firm conclusions.

Instead, escitalopram emerged as the strongest performer among drugs with more substantial supporting evidence.

Patients taking it had 62 per cent higher odds of recovering and remaining well than those prescribed Prozac.

Escitalopram belongs to a widely prescribed class of antidepressants known as selective serotonin reuptake inhibitors (SSRIs), which work by increasing levels of the brain chemical serotonin.

It is also used to treat anxiety and is sometimes prescribed for conditions such as obsessive compulsive disorder.

Coming second in the rankings was duloxetine, with patients having 57 per cent higher odds of recovering and remaining well than those taking Prozac.

Agomelatine came third, with 40 per cent higher odds.

Two other commonly prescribed drugs, citalopram and sertraline, also performed better than Prozac, although the differences were too small for researchers to be confident they were genuinely more effective.

‘Escitalopram is already widely used,’ said lead researcher Dr Paul van Haaren.

‘Agomelatine works well, but one of its side effects is the risk of liver failure. Duloxetine is less well known and is prescribed less frequently as a first-line treatment.’

At the other end of the rankings, three antidepressants performed worse than Prozac.

Patients taking venlafaxine had 12 per cent lower odds of sustained recovery, while the figures were 32 per cent lower for reboxetine and 34 per cent lower for bupropion.

Professor Eric Ruhe, an expert in difficult-to-treat depression at Radboud University Medical Centre, said the findings could influence which antidepressants doctors prescribe in future.

‘Of these SSRIs, escitalopram now appears to be the most effective, also for long-term use,’ he said.

‘This study may have implications for future treatment guidelines.’

However, he cautioned that the results did not mean escitalopram was necessarily the best choice for every patient.

Different antidepressants can cause different side effects, and a drug that works well for one person may be unsuitable for another.

‘As a prescriber, you consider the balance between a medication’s benefits and side effects,’ he explained.

‘That balance differs from person to person. Therefore, the choice of medication may vary for each individual patient.’

He added that the findings should help doctors and patients make more informed decisions about treatment, choosing medications that ‘not only help you to get well, but also keep you well’.

It is a point echoed by the Daily Mail’s resident psychiatrist and weekly columnist, Dr Max Pemberton.

Writing in this newspaper last year, Dr Max warned that when it comes to antidepressants, ‘one size definitely does not fit all’.

Drawing on his years of experience as a consultant psychiatrist, he compiled an expert guide to which of the most commonly prescribed antidepressants work best for different patients – and who might be better off avoiding them.

Read on for Dr Max’s recommendations.