Most Prescribed Antidepressant in the United States
Sertraline and citalopram are the most commonly prescribed antidepressants in clinical practice, with sertraline being prescribed to approximately 19.9% of patients with major depressive disorder and citalopram to 22.2%. 1
Prescription Patterns in Clinical Practice
Based on a large population-based study of over 54,000 insured patients with major depressive disorder in 2013, the three most frequently prescribed antidepressants were:
- Citalopram (22.2% of patients) - most commonly prescribed at 20 mg daily 1
- Sertraline (19.9% of patients) - most commonly prescribed at 50 mg daily 1
- Trazodone (17.6% of patients) - most commonly prescribed at 100 mg daily 1
Historical Context and Class Dominance
Selective serotonin reuptake inhibitors (SSRIs) have become the most commonly prescribed antidepressant class in the United States, with antidepressants overall representing the second most commonly prescribed drug class (13% of all prescriptions). 2 From 2007 to 2010,8.7% of Americans reported taking an antidepressant in the past 30 days, compared to only 1.8% from 1988 to 1994, representing a nearly five-fold increase. 2
Fluoxetine (Prozac) historically ushered in the modern era of antidepressant prescribing and transformed psychiatric pharmacology, though it is no longer among the most commonly prescribed agents. 2
Why These Agents Dominate Prescribing
The dominance of sertraline and citalopram in clinical practice aligns with guideline recommendations:
- Sertraline is recommended as the primary first-line option due to its favorable side effect profile, lower potential for drug interactions, and extensive safety data across diverse populations 3
- Citalopram and escitalopram (the active enantiomer of citalopram) are equally effective alternatives with similar tolerability profiles 3, 4
Important Clinical Caveat
While citalopram is the most prescribed antidepressant by volume, prescribers must not exceed 20 mg/day in patients over 60 years of age due to dose-dependent QT prolongation risk, as mandated by the 2012 FDA boxed warning. 5 This safety concern may shift prescribing patterns toward sertraline or escitalopram in older adult populations.