Treatment of First-Episode Major Depressive Disorder

Pharmacologic Treatment

• The American College of Physicians recommends SSRIs as the preferred first-line pharmacologic treatment for MDD, listing both escitalopram and paroxetine as acceptable options 1
• No guideline evidence suggests any specific advantage of paroxetine over escitalopram 2, 3, 4
• Moderate-quality evidence shows no difference in response or remission when comparing various SSRIs (including fluoxetine, fluvoxamine, paroxetine, sertraline, and escitalopram) to each other or to cognitive behavioral therapy 2

Monitoring and Treatment Duration

• Monitor response using standardized measures (such as a depression scale) at each visit 1
• Allow adequate trial duration of 4-8 weeks at therapeutic dose before declaring treatment failure 1