New anti-depressant awaited; little proof it's much better

WASHINGTON -- Starting next week, psychiatrists will be able to prescribe an eagerly awaited new anti-depressant called Lexapro. It's being promoted as more potent and possibly safer than older competitors -- but there's little evidence that it's much better.

Still, Lexapro promises to be a big player in the $12 billion anti-depressant market. So how do patients and doctors choose whether to try it or another of the bewildering array of depression drugs?

"You're playing the odds," is the blunt way Dr. Philip Ninan of Emory University puts it: Each anti-depressant comes with a different set of pros and cons, and there's little way to know in advance which will work best for which patient.

While patients today have better drugs than ever to fight depression, a huge swath of the 19 million Americans afflicted at some point in their lives fail to get relief. Experts estimate up to half of patients who try an anti-depressant stop altogether or switch to another within three months. Some can't handle the side effects; others get little or no benefit.

Today's medications emphasize balancing brain levels of the feel-good neurochemical serotonin. Ninan is excited about a different approach, targeting hormones believed to cause patients with depression to have exaggerated responses to stress.

'Not God's answer'

But with potential breakthroughs far away, any new option causes excitement -- even if, like Lexapro, the drug isn't much different from its predecessors. Indeed, Lexapro is a fine-tuned version of the popular drug Celexa, the latest in the class of "selective serotonin re-uptake inhibitors," or SSRIs.

Lexapro is "not God's answer to this illness, but it is a step forward," Ninan said. "The word I'd use is an incremental advance."

Forest Laboratories Inc., maker of both Celexa and Lexapro, argues that even an incremental advance means Lexapro can make a meaningful difference. So when Lexapro hits pharmacy shelves Sept. 5, the company will virtually end its Celexa marketing -- meaning few if any free samples anymore -- in favor of Lexapro, which will sell for 5 to 10 percent less than its roughly $2-a-pill predecessor.

"We're arguably taking a little bit of a gamble on this, but we believe we have a better drug," said Forest Vice President Dr. Lawrence Olanoff.