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Escitalopram is by far the most effective SSRI

22K views 28 replies 15 participants last post by  Kon 
#1 ·
Ive allways been skeptical of the SSRI's due to the low remission rates, however it appears that escitalopram is alot more effective then the other SSRI's with less side effects.

Curr Med Res Opin. 2010 Nov 1. [Epub ahead of print]
Comparison of escitalopram vs. citalopram and venlafaxine in the treatment of major depression in Spain: clinical and economic consequences.

Sicras-Mainar A, Navarro-Artieda R, Blanca-Tamayo M, Gimeno-de la Fuente V, Salvatella-Pasant J.

Badalona Serveis Assistencials, SA, Department of Planning, Badalona, Spain.
Abstract

Abstract Study objective: Population based study to determine the clinical consequences and economic impact of using escitalopram (ESC) vs. citalopram (CIT) and venlafaxine (VEN) in patients who initiate treatment for a new episode of major depression (MD) in real life conditions of outpatient practice. Methods: Observational, multicenter, retrospective study conducted using computerized medical records (administrative databases) of patients treated in six primary care centers and two hospitals between January 2003 and March 2007. Study population: patients >20 years of age diagnosed with a new episode of MD who initiate treatment with ESC, CIT or VEN who had not received any antidepressant treatment within the previous 6 months, and were followed for 18 months or more. Main variables: socio-demographic variables, remission (defined as a patient completing 6 months of therapy), comorbidity, annual health care costs (medical visits, diagnostic and therapeutic tests, hospitalizations, emergency room and psychoactive drugs prescribed) and non-health care costs (productivity losses at work, mainly sick leave and disability). Statistical analyses: logistic regression and ANCOVA models. Results: A total of 965 patients (ESC = 131; CIT = 491; VEN = 343) were identified and met study criteria. ESC-treated patients were younger, with a higher proportion of males, and had a lower specific comorbidity (p < 0.01). ESC-treated patients achieved higher remission rates compared to CIT (58.0% vs. 38.3%) or VEN patients (32.4%), p < 0.001, and had lower productivity work losses compared to VEN patients (32.7 vs. 43.8 days), p = 0.042. No differences in productivity work losses were observed between ESC and CIT patients. Compared to the ESC group, higher costs in average/unit of psychoactive drugs were found in the VEN group (€643.00), p = 0.003, whereas no differences were observed between the ESC and CIT groups (€294.70 vs. €265.20). In the corrected model, total costs (health care and non-health care cost) were lower with ESC (€2276.20) compared to CIT (€3093.80), p = 0.047 and VEN (€3801.20), p = 0.045. Conclusions: ESC appears to be dominant in the treatment of new MD episodes when compared to CIT and VEN, resulting in higher remission rates and lower total costs.

PMID: 21034375 [PubMed - as supplied by publisher]
Int J Neuropsychopharmacol. 2010 Sep 29:1-8. [Epub ahead of print]
Efficacy of escitalopram compared to citalopram: a meta-analysis.

Montgomery S, Hansen T, Kasper S.

University of London, UK.
Abstract

The aim of this review was to assess the clinical relevance of the relative antidepressant efficacy of escitalopram and citalopram by meta-analysis. Studies in major depressive disorder (MDD) with both escitalopram and citalopram treatment arms were identified. Adult patients had to meet DSM-IV criteria for MDD. The primary outcome measure was the treatment difference in Montgomery-Asberg Depression Rating Scale (MADRS) total score at week 8 (or last assessment if <8 wk). Secondary outcome measures were response (⩾50% improvement from baseline) and remission (MADRS ⩽12). A search of the literature and websites found eight randomized controlled trials (RCTs) and onr naturalistic trial, with a total of 2009 patients (escitalopram, n=995; citalopram, n=1014). Escitalopram was significantly more effective than citalopram in overall treatment effect, with an estimated mean treatment difference of 1.7 points at week 8 (or last assessment if <8 wk) on the MADRS (95% CI 0.8-2.6, p=0.0002) (six RCTs used the MADRS), and in responder rate (8.3 percentage points, 95% CI 4.4-12.3) (eight RCTs) and remitter rate (17.6 percentage points, 95% CI 12.1-23.1) analyses (reported for four RCTs), corresponding to number-needed-to-treat (NNT) values of 11.9 (p<0.0001) for response and 5.7 (p<0.0001) for remission. The overall odds ratios were 1.44 (p<0.0003) for response and 1.86 (p<0.0001) for remission, in favour of escitalopram. In this meta-analysis, the statistically significant superior efficacy of escitalopram compared to citalopram was shown to be clinically relevant.

PMID: 20875220 [PubMed - as supplied by publisher]
Encephale. 2010 Oct;36(5):425-432. Epub 2010 Oct 12.
[Efficacy of escitalopram vs paroxetine on severe depression with associated anxiety: Data from the "Boulenger" study.]

[Article in French]

Chauvet-Gélinier JC.

Service de psychiatrie et d'addictologie, hôpital Général, CHU de Dijon, 3, rue du Faubourg-Raines, 21000 Dijon, France.
Abstract

Several recent studies have underlined the importance of anxiety in major depressive disorders. It has been shown that anxiety was responsible for worsening of depression and reduction of the efficacy of the antidepressant treatment. While it is well known that SSRI are efficient in treating depression or anxiety disorders, the authors tried to determine the influence of baseline anxiety on the response to SSRI treatment in patients with severe depression receiving either escitalopram or paroxetine. In a 24-week double-blind clinical trial, 459 patients with a primary diagnosis of severe major depressive disorder were randomised to receive escitalopram (20mg) or paroxetine (40mg). Post hoc analyses of efficacy in patients with a baseline HAM-A total score less or equal to 20 (n=171) or greater than20 (n=280) were based on analysis of covariance. (ANCOVA) (ITT, LOCF). At week 24, the mean change from baseline in MADRS total score was -24.2 for escitalopram-treated patients (n=141) and -21.5 for paroxetine treated patients (n=139) (p<0.05, between both groups) in high baseline anxiety patients (HAM-A>20) and the mean change from baseline in HAM-A total score was -17.4 (escitalopram) and -15.1 (paroxetine) (p<0.05, between both groups). As far as complete remitters (CGI-S=1) after 24-week treatment were concerned, their number was significantly higher with escitalopram in the case of marked baseline anxiety. No difference was shown in the low baseline anxiety group. Looking for the influence of baseline anxiety on SSRI treatment effects, the authors showed that antidepressant efficacy of 20mg escitalopram was better than 40mg paroxetine for patients highly depressed with comorbid anxiety symptoms and that, contrary to paroxetine, escitalopram maintained sustained antidepressant activity in patients featuring increased baseline anxiety levels.
Copyright © 2010 L'Encéphale, Paris. Published by Elsevier Masson SAS. All rights reserved.

PMID: 21035633 [PubMed - as supplied by publisher]
J Sex Marital Ther. 2005 May-Jun;31(3):257-62.
Improvements in SSRI/SNRI-induced sexual dysfunction by switching to escitalopram.

Ashton AK, Mahmood A, Iqbal F.

School of Medicine, State University of New York at Buffalo, Buffalo, New York 14221, USA.
Abstract

Antidepressants, especially serotonin reuptake inhibiting agents, are associated with sexual dysfunction. The newest drug of this class, escitalopram, claims greater tolerability than older alternatives. This study evaluated patient experiences with switching from one serotonin enhancing antidepressant to escitalopram in individuals who already were complaining of antidepressant-induced sexual dysfunction. We found that 68.1% of patients experienced improvement with their sexual function. The ability to obtain a satisfactory clinical response at relatively low doses may explain this finding. We performed gender, phase of sexual response,and dose analyses. This article discusses results and significance.

PMID: 16020143 [PubMed - indexed for MEDLINE]
Source
 
#2 ·
Thanks for the studies. I'm kinda glad I'm taking escitalopram because zoloft gave me major headaches. My psychiatrist also thinks that on average escitalopram is the best SSRI for people with anxiety but just to post some skeptical views on those reviews:

"Finally, just for a sense of perspective, here's what happened in a couple of other recent antidepressant beauty contests. As you can see, they don't really agree on much...

  • Gartlehner et. al. (2008) concluded that "Second-generation antidepressants did not substantially differ in efficacy or effectiveness for the treatment of major depressive disorder on the basis of 203 studies; however, the incidence of specific adverse events and the onset of action differed."
  • Montgomery et. al. (2007) said that "[in "moderate-to-severe depression"] three antidepressants met these criteria [for superiority to any other drug]: clomipramine, venlafaxine, and escitalopram. Three antidepressants were found to have probable superiority: milnacipran, duloxetine, and mirtazapine." Note that clomipramine is an older drug not considered in the Lancet paper.
  • Papakostas et. al. (2008) report that "These results suggest that the NRI reboxetine and the SSRIs differ with respect to their side-effect profile and overall tolerability but not their efficacy in treating MDD"
http://neuroskeptic.blogspot.com/2009/02/whats-best-antidepressant.html

"The search phrase that most often leads people to this blog is "best antidepressant". People really want to know which antidepressant is most likely to help them. In truth, everyone responds differently to every drug, so there is no one best treatment. But Cipriani et al are quite right that even a roughly correct ranking could help improve the treatment of people with depression, even if the differences are tiny. If Drug X helps 1% more people than Drug Y on average, that's a lot of people when 30 million Americans take antidepressants every year.

So, what is the best antidepressant, on average? I don't know. But maybe it's escitalopram or sertraline. Stranger things have happened."

http://neuroskeptic.blogspot.com/2009/10/more-antidepressant-debates.html
 
#3 ·
ESC-treated patients achieved higher remission rates compared to CIT (58.0% vs. 38.3%) or VEN patients (32.4%)
Good thing you switched to escitalopram, i would say that this is absolutely the best SSRI to start with since i would consider the remission rates of the others completely pathetic, according to the last meta analysis ive read thats 25% better then placebo.

The reviews that blog talk about only looked at marginal differences AFAIK, however we see here that remission with lexapro is allmost 60%, while the others have a remission rate around the 30%, a big difference and i think its safe to conclude lexapro is far superior.
 
#5 ·
Everyone responds differently to different medications. Some (like me) respond well to Lexapro, but some don't and should try something else.

The good thing about Lexapro is that its side effect profile is quite favorable compare to other SSRIs. It causes little to no weight gain and sexual dysfunction. It always has fewer drug-drug interactions compared to other SSRIs. The downside is no generic version of Lexapro is available on the market yet, so the drug is very expensive and may not be covered by some insurance plans.
 
#6 ·
You're right about the side effects....I experienced none (compared to the Seroquel XR my wacky doc put me on when I was suicidal). One of the reasons why I stopped (in addition to it not working) was finances. I simply could not afford something that did not work.

My shrink tells me that he does not think medications work for me. (I guess because Lexapro didn't...since it is one of the best?)

So I continue attending therapy....which does not work for me either.

Throwing away money for therapy and medications that only worsen my situation by increasing my hopelessness....all a vicious and pointless cycle.
 
#10 ·
what about pristig newer med too maybe meta anylasis will come in a few years and pristiq is going to be the most effective lol.

I started pristiq 15 days ago and i can see it is helping me with social anxiety but i have some side effect that shrink said it will pass once my body get used to it and that is i have more energy and find it hard to stay or lay still like anxiety through out my body but it helps my social anxiety weird lol.
 
#12 ·
The problem is, 20mg of lexapro might help with depression, but it will probably destroy any sembalance of libido you may have. Lexapro is a potent med, and if you check out askpatient.com the large majority will report a total loss of libido at that dosage.

I've heard that even 5mg of lexapro can totally destroy libido :blank

The question for people to ask, whats better? To be depressed and horny? Or to be happy and sterile? It's a tough decision. But for me, i'd rather be depressed and horny because at least I can have sex and that makes me happy :)

OTOH, if I was happy but I couldn't be intimate with my gf, that would freakin' suck balls. No pun intended!!!!!

I have prescriptions for both lexapro and celexa but i only gave 'em about a week because even in just a week, my d*ck felt numb and i lost my libido. That was enough for me to quit it.

I'm on Wellbutrin now, and although it doesn't boost my libido it doesn't destory it either.


Cheers,
 
#14 ·
The question for people to ask, whats better? To be depressed and horny? Or to be happy and sterile? It's a tough decision. But for me, i'd rather be depressed and horny because at least I can have sex and that makes me happy :)
I am incredibly horny all the time (I have high levels of testosterone, so that may attribute to that), and when I am depressed I get my mind off my depression by finding someplace quiet and...well you get the idea.

Lexapro did not decrease my libido at all. In fact, I got so scared after hearing all the stories of delayed ejaculation that I jerked-off more frequently to keep myself in check.
 
#17 ·
Guys, if SSRI's dont work there are things that can be tried like dopaminergics, when those dont work it doesnt mean AT ALL that medication wont work, far from it actually.
 
#18 ·
Yeah It doesn't matter how good someone responds to an SSRI, the SSRI can never perform as well and as powerful, as an unselective MAOI. People need to get this in mind before claiming SSRI A, B or C is the holy grail.

The SSRI's are a lottery in which most patients have to go on a merry go round to find the right one for them. This is costly and takes a lot of time. Sometimes patients don't respond to any of them, this happened to me.

If doctors were smarter, they would go back to prescribing the far more effective medications like Tricyclics and the MAOI's almost straight away.

Unfortunately the medicine industry has educated doctors away from these drugs since the 1980's when Prozac first appeared.
 
#19 ·
Yeah MAOI's work very well for social anxiety, or amphetamine is another excellent option.
 
#20 ·
I found Lexapro and Paxil to both be effective SSRIs for me for SA. Zoloft less so, and St John's Wort did about nothing for anxiety. All were effective for depression. Lexapro made me more tired, and Paxil seemed slightly more effective for me; it is a dirtier SSRI, maybe that's why.
 
#21 ·
Lexapro also appears to be very effective in doses of 2,5mg, this is the best dose to start with, isntead of 10mg, many side effects can be avoided.
 
#23 ·
I'm liking my 20mg of Lexapro, no side effects. But of course just because its working for me, doesn't mean its the most effective one out there. Its sounds like the numbers are there however to show it might be the best starting point for doctors to prescribe, then move on to try others if its not the right fit. MAOIs I thought have greater risks? so wouldn't you start with the safer and then try the MAOI's? And I think the point/hope is to narrow down the best few SSRI's so you don't have to try a million for years before trying the other class of drugs.
 
#24 ·
Has anyone had a COMPLETELY different experience with different SSRI's? Not talking about small/big differences in effectiveness (or lack of), anxiety relief, stimulation etc, but about a totally different feeling/perception. Like a "wow, now this is something else" feeling?
(and leaving out side effects)
 
#28 ·
Has anyone had a COMPLETELY different experience with different SSRI's? Not talking about small/big differences in effectiveness (or lack of), anxiety relief, stimulation etc, but about a totally different feeling/perception. Like a "wow, now this is something else" feeling?
(and leaving out side effects)
I doubt it, the SSRI's seem to be a rather lackluster treatment for SA unfortunately.
 
#25 ·
Also i think remember study's showing that lexapro starts showing its antidepressant effects after 2 weeks allready and you dont have to wait the full 4 weeks as with others, i'l try to dig them up again, without a doubt lexapro should be the first SSRI tried.
 
#26 ·
By far i think pristiq is good medication helped my social anxiety after two weeks and and my side effect are much less now after two days so i like this drug more than lexapro i give it 9 out of 10 for social anxiety and better mood more energized. I think anyone who did't respond to ssri to try snri you have nothing to loose and i added abilify so i am pretty pleased with the two drugs.
 
#27 ·
I took celexa..similar to lexapro. It didn't help me at all. It numbed me sorta but that was it. I have read zoloft and lexapro are the 2 superior ones and have started zoloft 50mg 5 weeks ago. I knew the feeling celexa gave me and feel lexapro would make me just more numb..a zombie. But anyways so far zoloft week 5.. social anxiety is better..nothing major but definetly significant...depression I am not too sure about I feel there is a slight benefit but feel depression takes more time than 5 weeks.
 
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