What are the comparisons of Fluoxetine (Selective Serotonin Reuptake Inhibitor - SSRI)?

From the Guidelines

Fluoxetine is as effective as other selective serotonin reuptake inhibitors (SSRIs) in treating major depressive disorder (MDD), with no significant differences in effectiveness among different SSRIs 1.

Comparison of Fluoxetine with Other SSRIs

• The study by the American College of Physicians found that there were no significant differences between SSRIs or between SSRIs and other second-generation antidepressants in terms of effectiveness for acute phase treatment of MDD 1.
• A meta-analysis of 5 studies comparing citalopram with escitalopram showed a small but statistically significant benefit of escitalopram, but the clinical significance of this finding was doubtful 1.
• Fluoxetine has a longer half-life compared to other SSRIs, which can provide a built-in tapering effect if doses are missed and reduce discontinuation symptoms, making it useful for patients with difficulty adhering to medication regimens 1.

Quality of Life and Response to Treatment

• Evidence from 18 fair-quality efficacy trials showed no differences among second-generation antidepressants, including fluoxetine, in terms of quality of life or functional capacity as secondary outcomes 1.
• Fluoxetine, paroxetine, and sertraline were found to similarly improve health-related quality of life, including work, social and physical functioning, concentration and memory, and sexual functioning 1.
• Mirtazapine was found to have a faster onset of action compared to fluoxetine, but response rates were similar after 4 weeks of treatment 1.

Side Effects and Safety

• Common side effects of fluoxetine include nausea, headache, insomnia, sexual dysfunction, and increased anxiety during initial treatment 1.
• Fluoxetine has more drug interactions than some newer SSRIs due to its effects on liver enzymes, and is generally not preferred over sertraline and citalopram during pregnancy, although it is considered relatively safe during breastfeeding 1.

From the FDA Drug Label

Studies comparing fluoxetine 20,40, and 60 mg/day to placebo indicate that 20 mg/day is sufficient to obtain a satisfactory response in major depressive disorder in most cases The comparisons of Fluoxetine (Selective Serotonin Reuptake Inhibitor - SSRI) are as follows:

• Dose comparison: 20 mg/day is sufficient to obtain a satisfactory response in major depressive disorder in most cases, compared to 40 and 60 mg/day.
• Placebo comparison: Fluoxetine 20,40, and 60 mg/day are compared to placebo, indicating the efficacy of fluoxetine in major depressive disorder. No direct comparisons with other SSRIs are mentioned in the provided drug labels 2 2.

From the Research

Comparisons of Fluoxetine with Other Antidepressants

• Fluoxetine is equally effective compared to other SSRIs and tricyclic antidepressants (TCAs) in the treatment of depression in patients with HIV/AIDS 3.
• The efficacy of fluoxetine appears similar to that of desipramine in patients with stroke, cancer, or HIV, and is similar to that of sertraline or paroxetine in patients with HIV/AIDS 3.
• Fluoxetine has a more favorable tolerability profile for a similar efficacy in comparison to tricyclic antidepressants 4.
• Fluoxetine is as effective as tricyclic antidepressants, and appears more effective than placebo in improving the symptoms of depression 4.
• There is no scientific evidence to suggest that any one SSRI is more effective than another, but not all patients respond to the same agent 4.

Comparison of Fluoxetine with Sertraline

• A double-blind comparison of sertraline and fluoxetine in the treatment of major depressive episode in outpatients showed that both treatments produced a significant improvement over baseline on all efficacy variables, but the magnitude of global changes in depression, anxiety, and quality of life was larger with sertraline than fluoxetine 5.
• Significant differences in favor of sertraline were observed for individual HAM-D items, including insomnia onset, agitation, and general somatic symptoms 5.
• Sertraline was associated with significantly superior performance on the Leeds Sleep Evaluation scale and on SIP items relating to sleep and rest, emotional behavior, and ambulation 5.

Comparison of Fluoxetine with Other SSRIs

• Fluoxetine has shown superior efficacy compared to placebo in the treatment of depression in patients with HIV/AIDS, diabetes mellitus, or stroke, but has not significantly improved depressive symptoms versus placebo in patients with cancer 3.
• The potential for drug interactions with fluoxetine use should be carefully considered because most patients with comorbid physical illness will be receiving multiple comedications 3.
• Fluoxetine is generally safe and well-tolerated, with common adverse events reported with the recommended dose of 20 mg/day being referable to the gastrointestinal system and the nervous system 6.