First Top 10 List for Antidepressants

"For example, an agitation patient with severe insomnia may do best on Paxil, not Zoloft ... a patient with marked symptoms of psychomotor retardation may do best on Prozac. A patient with great concern about their libido may do best starting on Wellbutrin," Levy said.

But, in many cases, the first person to prescribe an antidepressant isn't a psychiatrist, it's a family physician. In that case, Levy might see use for such a ranking.

"It may greatly affect prescribing practices by non-psychiatric physicians, primary-care doctors in particular, who do most of the antidepressant prescribing, so it is good news for the generic makers of sertraline and for Forest Pharmaceuticals, who still have the patent on Lexapro," Levy said.

Other psychiatrists believed the rankings reflected their usual prescription decisions for patients trying antidepressants for the first time, anyway.

Trying Antidepressant No. 2

"I would be likely to start patients on either Zoloft [because it's cheaper] or Lexapro ...," said Dr. Harold G. Koenig, a professor of psychiatry and behavioral sciences at Duke University Medical Center in Durham, N.C.

"Unfortunately, that is almost none of my patients. By the time they get to me [a psychiatrist], the primary-care doctors have tried Zoloft and other antidepressants, so my patient are not the "new to medication" kind of patients," he said.

Still, Cipriani hopes the rankings will have an impact on depression treatment, even if psychiatrists use other ways to choose an antidepressant for their patients.

He hopes the ranking could be used as a measuring stick for all the new antidepressants coming to the market.

"When developing new drugs for treating depression, usually we have placebo controlled trials ... but before new treatments that are going to be on the market, we need an active comparable list," Cipriani said. "Perhaps the new drugs have to be better than the active standard."

As for Letourneau, he thinks beating depression requires the right drugs, but also a change in thinking.

"When people suffer from mental illness, they very often isolate themselves in life," Letourneau said. "The best thing is to get active. When you sit on your butt doing nothing, all you do is think about your problems.

"I volunteer every day in a place called the Genesis Club in Worcester, Mass," Letourneau said. "I feel great."

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