Escitalopram tolerability as mono- versus augmentative therapy in patients with affective disorders: a naturalistic study

Abstract

Background:Escitalopram is a selective serotonin reuptake inhibitor, widely used in the treatment of affective disorders. The purpose of this study was to examine its safety and tolerability, as mono- versus augmentative therapy, in a group of patients with affective disorders.Materials and methods:The sample consisted of 131 patients suffering from different affective disorders, including major depressive disorder, bipolar disorder, and generalized anxiety disorder, who received escitalopram for at least 4 weeks. Data were analyzed on the basis of mono- versus augmentative therapy, as well as age, gender, mean daily dosage, and patterns of combination therapy.Results:Sixty-seven (51.1%) patients were treated with monotherapy (mean dose of 11.76 mg/day) and 64 (48.9%) with augmentative escitalopram (mean dose of 12.81 mg/day). The mean duration of escitalopram treatment was 14 months. The most frequently combined compounds were: other antidepressants (36.5%), mood stabilizers (33.4%), and atypical antipsychotics (30.1%). Side effects were reported in 5.3% of the total sample and the most common were insomnia (2.3%), nausea (2.3%), and dizziness (0.8%). No significant difference, in terms of tolerability, in mono- versus augmentative therapy groups was found. In addition, neither age nor gender was significantly correlated with a greater presence of side effects. Finally, no significant correlation between dosage and side effects was observed.Conclusion:Over a 14-month observation period, escitalopram, either as monotherapy or an augmentative treatment, was found to be well tolerated in a large sample of patients with affective disorders, with an overall low rate of side effects.

Dosage-related nature of escitalopram treatment-emergent mania/hypomania: a case series

“…Antidepressant medications are frequently prescribed for bipolar disorder, and approximately half of patients with bipolar disorder take antidepressants without mood stabilizers. 54 , 55 Although escitalopram tolerability and efficacy have been assessed in the case of monotherapy or adjunctive therapy for bipolar depression, 31 , 56 the dosages of escitalopram used in these previous studies were lower than those applied in our patients, suggesting that escitalopram-induced manic switching might be dose-related. Therefore, the dose-related manic switching observed in the present study may have clinical and research implications if our observations can be replicated using larger samples.…”

“…Among SSRIs, escitalopram possesses the greatest serotonin transporter (5-HTT) selectivity, 29 with fewer adverse effects than other SSRIs. 30 , 31 While treatment-emergent mania/hypomania has been reported in a few clinical cases and one clinical trial, 32 – 34 it remains unknown whether this effect is dose-related.…”