From the Guidelines
Sertraline is the preferred first-line SSRI for depression in Australia, due to its favorable side effect profile and effectiveness across various depression severities. It is usually started at 50mg daily, taken in the morning, with the dose potentially increased to 100-200mg daily depending on response and tolerability 1. Treatment should continue for at least 6-12 months after symptom resolution to prevent relapse. Other commonly prescribed SSRIs in Australia include escitalopram, fluoxetine, and citalopram, which may be considered if sertraline is not tolerated or effective. Some key points to consider when prescribing SSRIs include:
- Common side effects, such as nausea, headache, insomnia, and sexual dysfunction, which often improve within the first few weeks of treatment 1
- The importance of monitoring patients for suicidal thoughts and behaviors, particularly in the first 1-2 months of treatment 1
- The need to assess patient status, therapeutic response, and adverse effects of antidepressant therapy on a regular basis, beginning within 1-2 weeks of initiation of therapy 1
- The potential for drug interactions and the need to consider patient preferences, cost, and dosing frequency when selecting an SSRI 1. Overall, the choice of SSRI should be based on a careful consideration of the individual patient's needs and circumstances, with sertraline being a commonly preferred option due to its favorable profile 1.
From the Research
First Line SSRI for Depression in Australia
The first line Selective Serotonin Reuptake Inhibitor (SSRI) for depression in Australia is not explicitly stated in the provided studies. However, the studies provide information on the effectiveness and tolerability of different SSRIs.
Effectiveness of SSRIs
- Fluoxetine, fluvoxamine, sertraline, paroxetine, and escitalopram are commonly used SSRIs for depression 2.
- A study found that fluoxetine was as effective as tricyclic antidepressants (TCAs) in reducing depressive symptoms 3.
- Another study found that paroxetine, fluoxetine, and sertraline were similar in effectiveness for depressive symptoms and health-related quality of life 4.
Tolerability of SSRIs
- Fluoxetine was found to be better tolerated than TCAs and some other antidepressants, with fewer dropouts due to side effects 3.
- Paroxetine, fluoxetine, and sertraline were associated with similar incidences of adverse effects and discontinuation rates 4.
Commonly Used SSRIs in Australia
- While the studies do not specifically mention the first line SSRI for depression in Australia, they suggest that fluoxetine, sertraline, and paroxetine are commonly used and effective options 5, 2, 3, 4.
- The choice of SSRI may depend on individual patient factors, such as medical history, concomitant medications, and personal preferences.