Experts call for wider use of tailored antidepressants over cheap generics

Researchers say it is overly simplistic to label antidepressants as simply “good” or “bad,” noting that while some drugs may cause physical side effects, they can also provide significant benefits.

Amitriptyline, for example, is linked to weight gain, increased heart rate, and higher blood pressure, but it can also help relieve pain and improve sleep. Selective serotonin reuptake inhibitors (SSRIs) – the most commonly prescribed class, including paroxetine, citalopram, escitalopram, and sertraline – generally showed fewer physical side effects. Fluoxetine (Prozac), however, was associated with weight loss and higher blood pressure in the study.

Prof. Andrea Cipriani of the University of Oxford said it is “impossible” to determine how many of the millions prescribed antidepressants might benefit from switching drugs. He noted that a longstanding focus on “generic, cheap medications” means that 85% of antidepressant prescriptions in the UK are for just three SSRIs: citalopram, sertraline, and fluoxetine.

Implementing the study’s findings, Cipriani said, could dramatically reduce this 85% share, allowing more patients to access treatments better suited to their needs. Researchers are also developing a free online tool to assist doctors and patients in selecting the most appropriate antidepressant, though widespread use would require a cultural shift within the NHS.

The study analyzed outcomes only eight weeks after starting treatment. Dr. Pillinger said complementary data suggest these short-term changes are likely to persist, but further testing is needed.

Dr. Prasad Nishtala of the University of Bath, who was not involved in the study, described the findings as “novel and valuable,” adding that in real-world settings where patients often take antidepressants for months or years, cumulative risks may be higher, particularly for those with chronic depression.