Fluoxetine (Prozac) versus ...
- Fluoxetine vs Citalopram
- Fluoxetine vs Paroxetine
- Fluoxetine vs Sertraline
- Fluoxetine vs Venlafaxine
- Fluoxetine vs Amitriptyline
Fluoxetine (Prozac) appears to be the weakest of the SSRIs. Due to its very long half-life and relatively weak potency as a serotonin inhibitor fluoxetine has less prominent discontinuation symptoms than many other antidepressants.
Fluoxetine unique features led to that Prozac is the only SSRI approved by the FDA for use in children 8 years of age and older.
Major depressive disorder
Citalopram is as effective as fluoxetine in the treatment of major depression. In the study citalopram showed an earlier onset of recovery than fluoxetine 12.
In the study patients treated with fluoxetine achieved a greater reduction in introjected anger, whereas those treated with citalopram achieved a greater reduction in depression feelings. Citalopram may be useful in depressed patients with bulimia, whereas fluoxetine is more specific for those with introjected anger and bulimia 13.
Sexual side effects
Citalopram delays ejaculation more significantly than fluoxetine 27.
Major depressive disorder
Paroxetine and fluoxetine have comparable efficacy in the treatment of depression. However, paroxetine has a significantly higher response rate than fluoxetine. Paroxetine appears to produce earlier antidepressant effect, improvement in agitation and anxiety symptoms 22, 23.
Constipation, indigestion, tremor, sweating and abnormal ejaculation are more common with paroxetine, whereas nausea and nervousness are more frequent with fluoxetine. Weight loss is more common with fluoxetine 23.
Discontinuation of paroxetine more often results in somatic and psychological symptoms than discontinuation of fluoxetine. Patients treated with fluoxetine appear to be protected by its longer half-life 1.
Sertraline and fluoxetine have comparable antidepressant efficacy in the treatment of Major depression. However, sertraline has advantages over fluoxetine in patients with severe depression or those with melancholia and low anxiety 17, 18.
Both medications are significantly effective in the treatment of moderate to severe OCD. However, patients treated with sertraline have a greater likelihood of remission as well as an earlier improvement 20.
Sertraline is considered to be better tolerated than fluoxetine 19.
Sertraline has advantages over fluoxetine on parameters such as sleep and weight disturbance in severely depressed patients, and sleep disturbance, weight, cognitive disturbance and retardation in melancholic patients 18.
Fluoxetine is associated with a higher incidence of agitation, anxiety and insomnia than sertraline 19.
Fluoxetine has fewer discontinuation-emergent events than sertraline 21.
Sertraline has significantly lower potential for drug interactions than fluoxetine.
Major depressive disorder
Venlafaxine appears to be superior to fluoxetine and produces higher rate of remission in the treatment for depression 24.
Venlafaxine therapy has superior remission rates in patients with severe anxiety and improves psychic anxiety better compared with fluoxetine. Superior efficacy of venlafaxine in depression may be attributed to early improvement in anxiety symptoms 25.
|Results of comparative study of venlafaxine vs. fluoxetine in the treatment of depression and anxiety 12.||Fluoxetine||Venlafaxine|
|Dosage||20 mg per day for 12 weeks||75 mg per day for 12 weeks|
|Response rate at week 12||
|Sustained response (for at least 2 weeks) at the end of the study||
|Conclusion:||Venlafaxine is significantly more effective than fluoxetine in improving depressive symptoms and concomitant anxiety.|
Onset of action -- no difference in speed of onset of action between bupropion and fluoxetine26.
Bupropion SR and fluoxetine are similarly effective and well tolerated in the treatment of depression. In clinical trials there were no statistically significant differences between both medications on any of the efficacy variables 15, 16.
|Results of placebo-controlled comparison of bupropion sustained release and fluoxetine 15.||Bupropion SR||Fluoxetine|
|Dosage||150-400 mg per day||20 to 60 mg per day|
|Efficacy||Similarly effective in the treatment of depressive symptoms.|
|Sexual side effects||Fluoxetine is more frequently associated with sexual dysfunction|
|Results of double-blind comparison of bupropion and fluoxetine for depression 16.||Bupropion SR||Fluoxetine|
|Dosage||225-450 mg per day||20-80 mg per day|
|50% or greater reduction in the HAM-D scores, number of patients, %||37 of 61 patients, 63%||35 of 62 patients, 58%|
|Much or very much improved number of patients, %||40 of 61 patients, 68%||35 of 62 patients, 58%|
|Prematurely discontinuation of treatment, number of patients||16 of 61 patients, 26%||18 of 62 patients, 29%|
Premenstrual Dysphoric Disorder
Fluoxetine is significantly superior to bupropion in the treatment of premenstrual dysphoric disorder 14.
|Results of placebo-controlled comparison of bupropion sustained release and fluoxetine 14.||Bupropion||Fluoxetine|
|Dosage||100 mg 3 times daily||20 mg daily|
|Efficacy||Some improvement was noted.||Fluoxetine was superior to bupropion. Patients satisfaction was far greater with fluoxetine.|
Fluoxetine and amitriptyline have comparable efficacy in the treatment of major depression with associated anxiety 3.
Fluoxetine and amitriptyline are similarly effective treatments for fibromyalgia, and they work better in combination than either medication alone 2.
In the study moderate or good pain relief was reported by 82% patients with amitriptyline, and by 77% patients with fluoxetine. Fluoxetine relieved low back pain and whiplash associated cervical pain as effectively as amitriptyline 4.
Amitriptyline appears to be more effective than fluoxetine for migraine headache prophylaxis9.
Adverse effects are more frequent and more severe with the amitriptyline 3. The most frequent side effects with fluoxetine are nausea, nervousness, sleep disturbances, and headaches; and dry mouth, dizziness, and drowsiness with amitriptyline 5, 6, 8. Weight gain is associated more with amitriptyline 7.
Major depressive disorder
Tolerability profiles are comparable except for changes in body weight. Mirtazapine is associated with significantly more pronounced body weight gain compared to the fluoxetine. In the study mirtazapine was associated with a mean weight gain of 0.8 +/- 2.7 kg, whereas fluoxetine was associated with a mean decrease in weight of 0.4 +/- 2.1 kg 10, 11.
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Published: March 31, 2008
Last updated: May 20, 2017