Prospective, multicentre, randomized, double-blind study of the efficacy of escitalopram versus citalopram in outpatient treatment of major depressive disorder

Abstract

Pre-clinical studies, active-control clinical trials and meta-analyses indicate that escitalopram (S-citalopram) might be more effective than citalopram, the racemic mixture of S- and R-citalopram. The present study aimed to confirm the superior efficacy of escitalopram over citalopram. A double-blind, randomized clinical trial was performed in which general practitioners and psychiatrists compared fixed doses of escitalopram (20 mg/day) with citalopram (40 mg/day) over 8 weeks in outpatients with major depressive disorder (MDD) [baseline Montgomery-Asberg Depression Rating Scale (MADRS) score > or =30]. Primary efficacy parameter was change from baseline to last assessment in the MADRS total score. Out of 138 (aged 44.1+/-10.9 years; initial MADRS score 36.3+/-4.8) and 142 (aged 46.2+/-11.1 years; initial MADRS score 35.7+/-4.4) evaluable patients who were randomized to escitalopram and citalopram, respectively, six and 15 withdrew prematurely (P=0.05). The MADRS score decreased more in the escitalopram than in the citalopram arm (-22.4+/-12.9 versus -20.3+/-12.7; P<0.05). There were more treatment responders with escitalopram (76.1%) than with citalopram (61.3%, P<0.01). Adjusted remitter rates were 56.1% and 43.6%, respectively (P<0.05). Tolerability was similar in both groups. This randomized double-blind trial confirms that escitalopram has a superior effect to citalopram in MDD.

Escitalopram in major depressive disorder: a multicenter, randomized, double-blind, fixed-dose, parallel trial in a Chinese population

“…Our study confirms that escitalopram is effective in the treatment of depression and is well tolerated [Burke et al, 2002;Lepola et al, 2003Lepola et al, , 2004Llorca et al, 2005;Moore et al, 2005]. Escitalopram 10 mg/day had comparable efficacy to fluoxetine 20 mg/day, based on the primary and secondary efficacy measurements (improvement in HAM-D-17 and MADRS total scores).…”

“…The antidepressant activity of escitalopram observed in validated animal models of depression [Hyttel et al, 1992;Mork et al, 2003;Sanchez and Kreilgaard, 2004], with evidence of a higher potency, was found to be superior to that of citalopram [Moore et al, 2005;Sanchez et al, 2003. Clinical studies have indicated that escitalopram 10 mg/day is an efficacious and well-tolerated treatment for MDD in both primary care [Wade et al, 2002] and specialist settings [Burke et al, 2002].…”

Selective Serotonin Reuptake Inhibitors, are They All Equal? A Pharmacoepidemiological Study

“…The superiority of escitalopram over other SSRIs has been demonstrated in head to head efficacy trials and meta-analyses [18][19][20]22,23,[32][33][34]. Escitalopram is the most specific SSRI, because of its unique pharmacological property: selected serotonin reuptake inhibition [11].…”

“…Most randomized clinical trials (RCT) compared citalopram to escitalopram and none of them showed any significant difference between the two regarding safety. However, escitalopram was significantly more effective in 3 studies [18][19][20] while no significant difference was found in 2 studies [21,22]. Two of the 3 studies comparing escitalopram with paroxetine showed the superiority of escitalopram with respect to both safety and efficacy [3,23,24].…”

Evidence-based choice and antidepressants treatment in psychiatry

“…Обратимся к таким зарубежным данным: суточная доза 20 мг эсциталопрама не менее эффек-тивна, чем 40 мг циталопрама (ципралекса) [78,79]; при переходе на эсциталопрам медицинские затра-ты в ряде зарубежных стран сокращены за счет сни-жения риска регоспитализации [32,47,[80][81][82]; острое лечение эсциталопрамом (10-20 мг/день) на 30% дешевле терапии венлафаксином 150 мг/сутки [83]. В РФ такой выгоды не достичь.…”