This Article  • Full text  • PDF  • Send to a friend  • Save in My Folder  • Save to citation manager  • Permissions  Citing Articles  • Citation map  • Citing articles on HighWire  • Citing articles on ISI (118)  • Contact me when this article is cited  Related Content  • Related letter  • Related articles  • Similar articles in JAMA  Topic Collections  • Primary Care/ Family Medicine  • Psychiatry  • Depression  • Quality of Life  • Randomized Controlled Trial  • Adverse Effects  • Alert me on articles by topic

A Randomized Trial

Kurt Kroenke, MD; Suzanne L. West, PhD; Ralph Swindle, PhD; Alicia Gilsenan, PhD; George J. Eckert, MAS; Rowena Dolor, MD; Paul Stang, PhD; Xiao-Hua Zhou, PhD; Ron Hays, PhD; Morris Weinberger, PhD

JAMA. 2001;286:2947-2955.

Context  Selective serotonin reuptake inhibitors (SSRIs) are the most commonly prescribed class of antidepressant, yet it is not known whether one SSRI is more effective than another.

Objective  To compare the effectiveness of 3 SSRIs (paroxetine, fluoxetine, and sertraline) in depressed primary care patients.

Design  Open-label, randomized, intention-to-treat trial, with patient enrollment occurring in April-November 1999.

Setting  Thirty-seven clinics in 2 US primary care research networks.

Patients  A total of 573 depressed adult patients for whom their primary care physician thought that antidepressant therapy was warranted and who completed a baseline interview.

Interventions  Patients were randomly assigned to receive paroxetine (n = 189), fluoxetine (n = 193), or sertraline (n = 191) for 9 months. Primary care physicians were allowed to switch patients to a different SSRI or non-SSRI antidepressant if they did not adequately respond to or tolerate the initial SSRI.

Main Outcome Measures  The primary outcome measure was change in the Medical Outcomes Study 36-Item Short-Form Health Survey (SF-36) Mental Component Summary score (range, 0-100), compared across treatment groups at 1, 3, 6, and 9 months. Secondary outcomes included other depression and psychological measures, multiple measures of social and work functioning, and other domains of health-related quality of life, such as physical functioning, concentration and memory, vitality, bodily pain, sleep, and sexual functioning.

Results  Follow-up interviews were successfully completed in 94% of patients at 1 month, 87% at 3 months, 84% at 6 months, and 79% at 9 months. Responses to the 3 SSRIs were comparable on all measures and at all time points. The mean change in the SF-36 Mental Component Summary score at 9 months was + 15.8 in the paroxetine group, + 15.1 in the fluoxetine group, and + 17.4 in the sertraline group. The drugs were also associated with similar incidences of adverse effects and discontinuation rates.

Conclusions  The SSRI antidepressants paroxetine, fluoxetine, and sertraline were similar in effectiveness for depressive symptoms as well as multiple domains of health-related quality of life over the entire 9 months of this trial.

Author Affiliations: Regenstrief Institute for Health Care and Department of Medicine, Indiana University School of Medicine (Drs Kroenke, Zhou, and Weinberger and Mr Eckert), Eli Lilly & Co (Dr Swindle), and Center for Health Services Research, Roudebush Veterans Affairs Medical Center (Dr Weinberger), Indianapolis; Department of Psychology, Indiana University, Bloomington (Dr Swindle); Research Triangle Institute (Drs West and Gilsenan), and Duke University School of Medicine and Duke Primary Care Research Consortium, Durham, NC (Dr Dolor); Primary Care Network, and Galt Associates, Philadelphia, Pa (Dr Stang); RAND Health Program and Department of Medicine, School of Medicine, University of California, Los Angeles (Dr Hays); and University of North Carolina, Chapel Hill (Drs West and Stang).

RELATED LETTER

Is One Selective Serotonin Reuptake Inhibitor Better Than Another?
Richard L. Elliott, Francis C. Dane, Spencer F. Stopa, Larry Culpepper, Timothy Heeren, Robert Keeley, Kurt Kroenke, George Eckert, Ralph Swindle, and Suzanne L. West
JAMA. 2002;287(15):1935-1938.
EXTRACT | FULL TEXT  

RELATED ARTICLES

Choosing a First-Line Antidepressant: Equal on Average Does Not Mean Equal for Everyone
Gregory Simon
JAMA. 2001;286(23):3003-3004.
EXTRACT | FULL TEXT  

December 19, 2001
JAMA. 2001;286(23):3023-3024.
EXTRACT | FULL TEXT  

THIS ARTICLE HAS BEEN CITED BY OTHER ARTICLES

Serum phospholipid n 3 long-chain polyunsaturated fatty acids and physical and mental health in a population-based survey of New Zealand adolescents and adults
Crowe et al.
Am. J. Clin. Nutr. 2007;86:1278-1285.
ABSTRACT | FULL TEXT  

Generic Fluoxetine and Choice of Antidepressant Medication
Sernyak and Rosenheck
Psychiatr. Serv. 2007;58:128-130.
ABSTRACT | FULL TEXT  

A Review of the STAR*D Trial
Ehret and Chavez
Journal of Pharmacy Practice 2006;19:353-360.
ABSTRACT  

Depression decision support in primary care: a cluster randomized trial.
Dobscha et al.
ANN INTERN MED 2006;145:477-487.
ABSTRACT | FULL TEXT  

Dose escalation for insufficient response to standard-dose selective serotonin reuptake inhibitors in major depressive disorder: Systematic review
RUHE et al.
Br. J. Psychiatry 2006;189:309-316.
ABSTRACT | FULL TEXT  

Job Performance Deficits Due to Depression
Adler et al.
Am. J. Psychiatry 2006;163:1569-1576.
ABSTRACT | FULL TEXT  

Hyponatremia Associated with Selective Serotonin-Reuptake Inhibitors in Older Adults
Jacob and Spinler
The Annals of Pharmacotherapy 2006;40:1618-1622.
ABSTRACT | FULL TEXT  

Depression and cardiovascular disease: healing the broken-hearted.
Whooley
JAMA 2006;295:2874-2881.
ABSTRACT | FULL TEXT  

Mental health in the medicare part d drug benefit: a new regulatory model?
Donohue
Health Aff (Millwood) 2006;25:707-719.
ABSTRACT | FULL TEXT  

Temporal Relation among Depression Symptoms, Cardiovascular Disease Events, and Mortality in End-Stage Renal Disease: Contribution of Reverse Causality
Boulware et al.
CJASN 2006;1:496-504.
ABSTRACT | FULL TEXT  

Responsiveness of the PHQ-9 to Psychopharmacological Depression Treatment
Lowe et al.
Psychosomatics 2006;47:62-67.
ABSTRACT | FULL TEXT  

The medical management of depression.
Mann
NEJM 2005;353:1819-1834.
FULL TEXT  

Efficacy and Safety of Second-Generation Antidepressants in the Treatment of Major Depressive Disorder
Hansen et al.
ANN INTERN MED 2005;143:415-426.
ABSTRACT | FULL TEXT  

Is Traditional Trial Design About to Be Replaced?
Rosack
Psychiatr. News 2005;40:34-34.
FULL TEXT  

Adherence to Mental Health Treatment in a Primary Care Clinic
Gonzalez et al.
J Am Board Fam Med 2005;18:87-96.
ABSTRACT | FULL TEXT  

Unemployment, Job Retention, and Productivity Loss Among Employees With Depression
Lerner et al.
Psychiatr. Serv. 2004;55:1371-1378.
ABSTRACT | FULL TEXT  

Change in Psychosocial Functioning and Quality of Life of Patients With Body Dysmorphic Disorder Treated With Fluoxetine: A Placebo-Controlled Study
Phillips and Rasmussen
Psychosomatics 2004;45:438-444.
ABSTRACT | FULL TEXT  

Listening To Generic Prozac: Winners, Losers, And Sideliners
Druss et al.
Health Aff (Millwood) 2004;23:210-216.
ABSTRACT | FULL TEXT  

Treatment of Depression in Cancer
Fisch
J Natl Cancer Inst Monogr 2004;2004:105-111.
ABSTRACT | FULL TEXT  

Response, Partial Response, and Nonresponse in Primary Care Treatment of Depression
Corey-Lisle et al.
Arch Intern Med 2004;164:1197-1204.
ABSTRACT | FULL TEXT  

Association of Utilization Management and Treatment Plan Modifications Among Practicing U.S. Psychiatrists
Mintz et al.
Am. J. Psychiatry 2004;161:1103-1109.
ABSTRACT | FULL TEXT  

Biodistribution and Imaging with 123I-ADAM: A Serotonin Transporter Imaging Agent
Newberg et al.
JNM 2004;45:834-841.
ABSTRACT | FULL TEXT  

Impact of Pain on Depression Treatment Response in Primary Care
Bair et al.
Psychosom. Med. 2004;66:17-22.
ABSTRACT | FULL TEXT  

Managed Care: Improving Psychiatric Drug Benefit Management: II. Kaiser Permanente's Approach to SSRIs
Sabin and Daniels
Psychiatr. Serv. 2003;54:1343-1349.
FULL TEXT  

Effect of Antidepressants and Their Relative Affinity for the Serotonin Transporter on the Risk of Myocardial Infarction
Sauer et al.
Circulation 2003;108:32-36.
ABSTRACT | FULL TEXT  

Willingness to Pay for Depression Treatment in Primary Care
Unutzer et al.
Psychiatr. Serv. 2003;54:340-345.
ABSTRACT | FULL TEXT  

Application of a Depression Management Office System in Community Practice: A Demonstration
Dietrich et al.
J Am Board Fam Med 2003;16:107-114.
ABSTRACT | FULL TEXT  

A Three-Component Model for Reengineering Systems for the Treatment of Depression in Primary Care
Oxman et al.
Psychosomatics 2002;43:441-450.
ABSTRACT | FULL TEXT  

Update in Psychiatry
Schneider and Levenson
ANN INTERN MED 2002;137:671-677.
FULL TEXT  

Treatment of Minor Depression
Oxman and Sengupta
AJGP 2002;10:256-264.
ABSTRACT | FULL TEXT  

When Are Medication Side Effects Due to the Nocebo Phenomenon?
Palmer et al.
JAMA 2002;287:2502-2504.
FULL TEXT  

Is One Selective Serotonin Reuptake Inhibitor Better Than Another?
Elliott et al.
JAMA 2002;287:1935-1938.
FULL TEXT  

The Costs of Making Practice More Cost-effective
Weeks et al.
JAMA 2002;287:1648-1650.
FULL TEXT  

A 75-Year-Old Man With Depression
Kroenke
JAMA 2002;287:1568-1576.
FULL TEXT  

Three SSRIs Are Equally Effective
JWatch Psychiatry 2002;2002:8-8.
FULL TEXT  

SSRIs Are Equally Effective
JWatch Women's Health 2002;2002:7-7.
FULL TEXT  

Three SSRIs Are Equally Effective
JWatch General 2002;2002:1-1.
FULL TEXT  

Choosing a First-Line Antidepressant: Equal on Average Does Not Mean Equal for Everyone
Simon
JAMA 2001;286:3003-3004.
FULL TEXT