Background: Most of the current knowledge about the effects of antidepressants is derived from randomized clinical trials (RCT) that are far from representing usual clinical practice. Observational studies can be useful adjuncts to RCTs for determining whether efficacy under controlled conditions could be translated into effectiveness in routine practice. Objective: The purpose of this study is to compare the effectiveness of Citalopram, fluoxetine, paroxetine, and sertraline for treating depression in Primary Care (PC). Design and setting of study: Prospective cohorts study with usual care pharmacological prescription and follow-up in 16 PC Centres in Spain. Subjects and main outcome measures: A total of 301 participants with a depressive disorder, treated under "usual care" conditions in PC, were followed-up for six months. Participants were assessed at baseline, and at 3 and 6 months. Outcome measures were depressive symptoms, evaluated by means of the Patient Health Questionnaire 9-item depression module, and health-related quality of life, evaluated by means of the EuroQol-5D. Additionally, diagnosis with the SCID interview, treatment patterns and compliance were evaluated. Results: Paroxetine (36.55%), fluoxetine (33.22%), sertraline (17.60%) and Citalopram (12.63%) were the antidepressants included in the analysis. Initial doses were adequate according to clinical guidelines and were mostly maintained throughout follow-up. No significant differences in effectiveness were observed among the antidepressants prescribed. Drop-out frequencies were not significantly different among antidepressants. Additionally, there were no differences among them regarding improvement in health-related quality of life. Conclusion: All four antidepressants were equally effective for treating depressive disorders in PC under "usual care" conditions. © 2006 LIBRAPHARM LIMITED.
- Major depression
- Primary care