OBJECTIVE: To evaluate the impact of Sertraline, Fluoxetine and Escitalopram monotherapy on psychological distress among adults with depression.

METHOD: The Medical Expenditure Panel Survey (MEPS) household component longitudinal data files from 2012-2019 (panel 17-23) were used. Study participants included adults above 19 years old, diagnosed with depression, and were on one of the aforementioned antidepressants. Participants who only initiated antidepressants at rounds 2 and 3 of each panel were included. The impact of the medicines on psychological distress was assessed using change in Kessler Index (K6) scores, which were measured only in rounds 2 and 4 of each panel. Changes in K6 scores ≤ 6 were identified as improvement, 7-12 (unchanged) and, > 12 (decline) in psychological distress. Multinomial logistic regression was conducted using change in K6 scores as a dependent variable. Independent variables included medication type, age, gender, and race.

RESULTS: 814 participants were included in the study. Sertraline (40%) was the most utilized medication. 72% of the study population were females. Non-Hispanic Whites represented 80% of the study population. The three medications were mostly utilized among age group 40-59 (37%). 90.79% of the participants taking any of the medications showed improvement in psychological distress. Fluoxetine had the highest improvement rate (91.87%) compared to Escitalopram (90.38%) and Sertraline (90.27%). Patients on Escitalopram (OR=0.66; P=0.247) and Sertraline (OR=0.85; P=0.631) were less likely to improve in psychological distress than patients on Fluoxetine. Generally, Blacks on SSRIs (OR=5.32; P=0.016) were more likely to decline in psychological distress than Whites.

CONCLUSION: All the medications effectively improved psychological distress, with Fluoxetine having the highest improvement rate. While Sertraline and Escitalopram were less likely to improve psychological distress than Fluoxetine, result was statistically insignificant possibly because of smaller sample size. Further study is needed to assess the comparative effectiveness and health-care utilization of these medications.