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A major new medical study shows Zoloft and Lexapro are the most effective and well-tolerated antidepressants among a group of 12 newer depression drugs.

Researchers report in the British medical journal "The Lancet" that either Lexapro or generic Zoloft should be used as the prescription drug of first choice for people with moderate to severe depression.

Doctors combed through the results of 117 studies involving nearly 26,000 patients on a dozen different antidepressants and concluded that Lexapro and generic Zoloft are the best when it comes to efficacy and tolerability.

U.S. sales of antidepressants totaled $12 billion in 2007, the last year for which data are available, according to IMS Health, making it the fourth-biggest segment of the pharmaceutical industry.

This kind of study, called a meta-analysis, is not considered the gold standard in medical research. But an accompanying editorial in "The Lancet" says the findings have "enormous implications" and "will surely change the tune" of prescribing psychiatrists. p>

&q"Now a clinician can identify the four best treatments, identify individual side-effect profiles, explore costs and patients' preferences and collaborate in identifying the best treatment," said Sagar Parikh, psychiatrist at the University of Toronto, who was not involved in the study. Parkikh is the author of the Lancet editorial.

Cheaper Antidepressant Medication Doesn't Always Mean Better

In the last quarter, sales of Forest Labs' Lexapro fell three percent, in part due to increased competition from cheaper, generic antidepressants.

Over the past decades, several new drugs have hit the market to treat depression, a leading cause of suicide that affects an estimated 121 million people worldwide. But many are similar in structure and the way in which they work, so it is unclear which ones work best, Andrea Cipriani and colleagues wrote in the journal Lancet.

"Moreover, some of these new drugs are so-called me-too drugs — chemically similar to existing drugs with expiring patents rather than giving genuine advances in treatment," they wrote.

Overall, Zoloft (sertraline) and Lexapro (escitalopram) were best when it came to both reducing symptoms after eight weeks and drop-out rates during the studies.

Far more people remained on the two drugs compared to antidepressants Cymbalta (duloxetine), Luvox (fluvoxamine), Paxil (paroxetine), Edronax (reboxetine) and Effexor (venlafaxine), the study showed.

The team, which also found Remeron and Effexor were more effective than the other drugs, did not look at things like side-effects, toxicity, how well people functioned socially while on the treatments, or cost-effectiveness.

"The most important clinical implication of the results is that Lexapro and Zoloft might be the best choice when starting a treatment for moderate to severe major depression because they have the best possible balance between efficacy and acceptability," the researchers wrote.

"The Lancet" says no drug companies had a hand in the study.

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