Fluoxetine versus sertraline and paroxetine in major depression: tolerability and efficacy in anxious depression

Background: Major depression with high levels of anxiety (anxious depressio n) is a common subtype of depression associated with greater psychosocial i mpairment and poorer response to antidepressant treatment. It is unclear wh ether in this population there are differences in efficacy or tolerability across selective serotonin reuptake inhibitors. For this reason, using head -to-head acute treatment comparison, we compared efficacy and tolerability of fluoxetine, sertraline, and paroxetine among depressed patients with hig h levels of anxiety. Methods: Patients (N = 108) with DSM-IV major depressi on and high levels of anxiety (a HAM-D-Anxiety/Somatization Factor score gr eater than or equal to 7) were randomized to fluoxetine, sertraline, or par oxetine treatment in a double-blind fashion. Changes in overall depression and anxiety were assessed. Results: Patients demonstrated similar baseline- to-endpoint improvement in HAM-D-17 and HAM-D-Anxiety/Somatization Factor s cores. Patients also demonstrated similar change-over-time improvement in H AM-D-17 and HAM-D-Anxiety/Somatization Factor scores, except at week one wh ere fluoxetine- and sertraline-treated patients had statistically significa ntly greater improvement than paroxetine-treated patients in the HAM-D-Anxi ety/Somatization Factor score. There were no significant differences across treatments in percentages of patients with substantial emergence, any wors ening, or improvement at endpoint in individual HAM-D Items 9 (agitation), 10 (psychic anxiety), and 11 (somatic anxiety). Overall, all treatments wer e well tolerated. Conclusion: These data showed no significant differences in efficacy and tolerability of fluoxetine, sertraline, and paroxetine in p atients with high levels of baseline anxiety symptoms during the acute trea tment of major depression. Each treatment was similarly effective in improv ing depression in this subtype df patients with anxious depression. (C) 200 0 Elsevier Science B.V. All rights reserved.