Depression Treatment with Fluoxetine and Sertraline

Comparative Efficacy

Both fluoxetine and sertraline are second-generation antidepressants with similar overall efficacy for treating major depressive disorder, according to the American College of Physicians 1, 2
The American College of Physicians notes that paroxetine has higher rates of sexual dysfunction than fluoxetine and sertraline, while bupropion has lower rates of sexual adverse events than both 1, 2

Common side effects for both medications include gastrointestinal issues, such as nausea, diarrhea, and constipation, as reported by the American College of Physicians 1
The American College of Physicians also notes that headache is a common side effect of both medications 1
Insomnia and somnolence are common side effects, according to the American College of Physicians 1, 3
Sexual dysfunction is a common side effect, as reported by the American College of Physicians 2, 3

For older adults, the American Academy of Family Physicians recommends citalopram, escitalopram, sertraline, mirtazapine, and venlafaxine due to their favorable adverse effect profiles 4
The American Academy of Family Physicians notes that fluoxetine has a greater risk of agitation and overstimulation in older adults and is not recommended for this population 4

The American Academy of Family Physicians suggests that sertraline and paroxetine transfer to breast milk in lower concentrations than other antidepressants, making them potentially safer options for breastfeeding mothers 5

The American Academy of Family Physicians recommends continuing treatment for 4-12 months after remission of a first episode of major depression 4
Patients with recurrent depression may benefit from prolonged treatment, according to the American Academy of Family Physicians 4

The American Academy of Family Physicians notes that inadequate duration of treatment is a common pitfall, and treatment should be continued for at least 4-12 months after remission 4
Overlooking side effects, such as nausea and vomiting, is a common pitfall, and management strategies should be considered, as reported by the American College of Physicians 3