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]
SourceJ 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]