A comparative analysis of fluoxetine and amitriptyline in depression: assessing effectiveness and adherence in a rural hospital setting

Background: Fluoxetine and amitriptyline are commonly prescribed antidepressants. However, the superior option in terms of effectiveness and adherence remains unclear. Medication non-adherence significantly impacts treatment outcomes. This study aims to compare the two drugs in terms of effectiveness and adherence, and to assess their correlation. Methods: This is a single-centered, prospective observational study, conducted in the psychiatric outpatient department (OPD) of the Government Medical College and Hospital, Nagapattinam, over six months (23 July 2024 to 22 January 2025). It included 126 patients newly diagnosed with depression. Patients receiving either fluoxetine or amitriptyline were enrolled. Effectiveness was measured using the 17-item Hamilton depression rating scale (HAM-D), calculating score reduction from baseline to endpoint. The four-item Morisky scale (MMAS-4) was applied to assess the medication adherence of the participants. Data were analysed with statistical package for the social sciences (SPSS) version 24, applying descriptive analysis, independent t-test and Pearson correlation as appropriate. Results: Depression was more prevalent among women. Most participants were married and unemployed. Fluoxetine showed a greater mean reduction in HAM-D scores compared to amitriptyline. It also demonstrated higher medication adherence. A statistically significant positive correlation between effectiveness and adherence was observed for both drugs. Conclusions: Better clinical outcomes were associated with higher medication adherence. Fluoxetine was superior to amitriptyline in both effectiveness and adherence. These findings highlight the importance of adherence in improving depression treatment outcomes.