Amaç: Bu çalışmada DSM - IV tanı ölçütlerine göre majör depresyon tanısı konulan ve ayaktan tedavi edilen 150 hastada beş özgül serotonin geri alım engelleyicisinin (SSRI) etkinliğinin karşılaştırılması amaçlanmıştır. Yöntem: 7 gün ilaçsız dönemi takiben 30'ar kişiden oluşan beş grup hastaya random usulü ile paroksetin, fluvoksamin, fluoksetin, sitalopram ve sertralin tedavisi başlanmış, depresyon düzeylerindeki düzelme dereceleri Hamilton Depresyon Değerlendirme ölçeği, Zung Depresyon ölçeği ve Beck Depresyon ölçeği kullanılarak saptanmıştır. Sonuçlar SPSS paket programı kullanılarak değerlendirilmiştir. Sonuç ve Yorum: Özgül serotonin geri alım engelleyicilerinin beşi de üç aylık tedavi süresinde antidepresan etkinlik göstermiş, ancak tedavinin başlangıç döneminde fluvoksamin tedavisi alan grupta iyileşme düzeyinin daha fazla olduğu izlenirken, özellikle tedavinin son ayında paroksetin tedavisi alan hastalardaki iyileşmenin daha fazla olduğu izlenmiştir. Bu farklı sonuçların ise ilaçların far-makokinetik özelliklerinden kaynaklanabileceği ve SSRI grubu ilaçların eşdeğer dozlarda ele alınabildiği farklı çalışmalarla bu sonucun yeniden değerlendirilebileceği kararına varılmıştır.

Purpose: In the literature there are paired studies which compare one selective serotonin reuptake inhibitors (SSRI) to each other, the results are various but one point they clear out is the effectiveness of each SSRI. Lack of multi comparison study in the literature led us to design this study. In the current study we aimed at comparing the effectiveness of fluoxetine, fluvoksamine, paroxetine, sertraline and citalopram to each other, and to add additional information to literature to answer a question often asked "whether any SSRI is superior to other in the tretament of depression". Method: Study consists of 150 outpatients with the diagnosis of major depression according to DSM - IV criteria. After a seven days wash out period, patients randomly received one of paroxetine, fluvoksamine, fluoxetine, citalopram or sertraline . Avarage paroxetine, fluvoksamine, fluoxetine, citalopram and sertraline doses were 35.66 mg/day, 246.66 mg/day, 36 mg/day, 28.66 mg/day, 61.66 mg/day respectively. Study groups consisted of 30 patients and patients with additional axis I diagnosis and mental retardation were excluded. Patients were evaluated by using the Hamilton Depression Rating Scale (HDS), Zung Depression Scale (ZDS) and Beck Depression Scale (BDS) at the baseline, 30th , 60 th and 90 th day of treatment. The results are compared by using one - way ANOVA and SheffeE multicomparison statistical method with the aid of SPSS package program. Results and Comments: 60% (n=90) of the patients were female and 40% (n=60) were male. 70% (n=105) were married and 30% (n=45) were single. Educational status were as follows. Primary school graduates: 34% (n=51), secondary school graduates: 38% (n=57) and university graduates: 28% (n=42). 82% (n=123) of the patients administered with the first attack, whereas 12.7% (n=19) were in the second, 4% (n= 6) were in the third and 1.3% (n=2) were in the forth attacks. 22.7 % (n=34) of the patients had a family history of depression. Baseline scores with the three scales showed no difference among the five groups (p<0.01). At the first month of tretment with regard to HDS and BDS there was a difference among the groups which resulted from fluvoksamine (p<0.01). In the second month of treatment the difference resulting from fluvoksamine continued (p<0.01). But in the third month of treatment fluvoksamine effect seemed to vanish but still significant to cause difference. Instead the differences among the groups in the third month of treatment resulted from paroxetine (p<0.01). Although there seems to be difference among the groups through the three month period, each agent caused significant decrease in the three depression scales. Results are compatible with the literature. All of five agents showed significant antidepressan efficacy although fluvoksamine and paroksetine's effects started earlier. Since SSRI's as a group exhibite same mechanism of action, the difference found in the studies can be the result of the pharmacokinetic properties of these agents. Studies using standardised dosage of SSRI's in the treatment of major depression may enlight this point.