Comparative Analysis of Escitalopram, Sertraline and Amitriptyline in Patients with Major Depressive Disorder in India: A Real-World Study

M ental health issues are a significant cause of non- fatal disease burden in India, with their proportional contribution nearly doubling since 1990.Major Depressive Disorder (MDD), characterized by persistent low mood, loss of interest in pleasurable activities, guilt, lack of energy, concentration difficulties, appetite changes, sleep disturbances and suicidal thoughts, is a prevalent condition.In 2019, the prevalence of MDD in the Indian population was 2.68%, with higher prevalence in the 40-59 years age group 1 .MDD can be managed with various treatment modalities.Per Indian Psychiatric Society (IPS) guidelines, treatment begins with thorough patient assessment and typically involves medication and/or psychotherapy.While some antidepressants show higher response rates in clinical trials, ongoing debate surrounds their efficacy and safety.Many patients experience only partial relief or relapse within weeks of treatment 2 .However, data on inadequate response and relapse rates in the Indian population is limited.In India, selective serotonin reuptake inhibitors (SSRIs) are the most commonly prescribed medicines for Depression 3 , followed by Tricyclic Antidepressants (TCAs) 4 .Despite their known Adverse Events (AEs), antidepressants are frequently prescribed.Escitalopram, despite causing more AEs and sexual disturbances compared to other antidepressants 5 , is the preferred monotherapy in >65% of patients 6 .Similarly, other commonly prescribed antidepressants like Sertraline and Fluoxetine also elicit multiple AEs 7 .Some antidepressants, like Escitalopram and Sertraline, have also been reported to induce suicidal ideation 8 , although conclusive data on this topic is limited 9 .Antidepressant use is considerable, especially in the Western World, and increasing in several countries 10 .