Escitalopram versus SNRI antidepressants in the acute treatment of major depressive disorder: integrative analysis of four double-blind, randomized clinical trials.

Abstract

INTRODUCTION:

Recent data suggest that escitalopram may be more effective in severe depression than other selective serotonin reuptake inhibitors.

METHODS:

Individual patient data from four randomized, double-blind comparative trials of escitalopram versus a serotonin/norepinephrine reuptake inhibitor (SNRI) (two trials with duloxetine and two with venlafaxine extended release) in outpatients (18-85 years of age) with moderate-to-severe major depressive disorder were pooled. The primary efficacy parameter in all four trials was mean change in the Montgomery-Asberg Depression Rating Scale (MADRS) score.

RESULTS:

Significantly fewer escitalopram (82/524) than SNRI (114/527) patients prematurely withdrew from treatment due to all causes (15.6% vs. 21.6%, Fisher Exact: P=.014) and adverse events (5.3% vs. 12.0%, Fisher Exact: P<.0001). Mean reduction in MADRS score from baseline to Week 8 was significantly greater for the escitalopram group versus the SNRI group using the last observation carried forward (LOCF) approach [mean treatment difference at Week 8 of 1.7 points (P<.01)]. Similar results were observed in the severely depressed (baseline MADRS score >or= 30) patient subset (mean treatment difference at Week 8 of 2.9 points [P<.001, LOCF]). Observed cases analyses yielded no significant differences in efficacy parameters.

CONCLUSION:

This pooled analysis indicates that escitalopram is at least as effective as the SNRIs (venlafaxine XR and duloxetine), even in severe depression, and escitalopram treatment was better tolerated.

• Authors: Susan G Kornstein, Dayong Li, Yongcai Mao, Sara Larsson, Henning F Andersen, George I Papakostas
• Journal: CNS spectrums (CNS Spectr) Vol. 14 Issue 6 Pg. 326-33 (Jun 2009) ISSN: 1092-8529 [Print] United States
• PMID: 19668123 (Publication Type: Journal Article, Meta-Analysis, Research Support, Non-U.S. Gov't)

Chemical References

• Cyclohexanols
• Serotonin Uptake Inhibitors
• Thiophenes
• Citalopram
• Venlafaxine Hydrochloride
• Duloxetine Hydrochloride

Topics

• Adolescent
• Adult
• Aged
• Aged, 80 and over
• Citalopram (therapeutic use)
• Cyclohexanols (therapeutic use)
• Depressive Disorder, Major (drug therapy)
• Double-Blind Method
• Drug Administration Schedule
• Duloxetine Hydrochloride
• Female
• Humans
• Male
• Middle Aged
• Outcome Assessment, Health Care
• Psychiatric Status Rating Scales
• Randomized Controlled Trials as Topic
• Selective Serotonin Reuptake Inhibitors (therapeutic use)
• Severity of Illness Index
• Thiophenes (therapeutic use)
• Time Factors
• Venlafaxine Hydrochloride
• Young Adult