Escitalopram for the management of major depressive disorder: a review of its efficacy, safety, and patient acceptability

Figures & data

Figure 1 Chemical structure of escitalopram.

Figure 2 Escitalopram showed 5-HT transporter occupancy that outlived its plasma concentration.

Copyright © 2007, Springer-Verlag. Adapted with permission from Klein N, Sacher J, Geiss-Granadia T, et al. Higher serotonin transporter occupancy after multiple dose administration of escitalopram compared to citalopram: an [123I]ADAM SPECT study. Psychopharmacology (Berl). 2007;191(2):333–339.¹³

Notes: Escitalopram (10 mg) was administered once daily for 10 consecutive days (the first 5 days are shown) to six healthy men. The 5-HT transporter occupancy rate was determined in the midbrain-hypothalamus region. The 5-HT transporter occupancy rate of escitalopram peaked at 80% and the occupancy half-life was 130 hours.

Table 1 Comparison of changes in total MADRS scores at 8 weeks (last observation carried forward) among patients with MDD treated with escitalopram, paroxetine, or placebo

	Escitalopram 10 mg (n = 120)	Escitalopram 20 mg (n = 119)	Escitalopram combined groups (n = 239)	Paroxetine (n = 121)	Placebo (n = 124)
Total scorea
At baseline	29.4 ± 5.8	29.8 ± 6.0	29.6 ± 5.9	29.8 ± 5.9	29.0 ± 5.6
At week 8	15.6 ± 11.0	16.2 ± 10.1	15.9 ± 10.5	15.6 ± 10.0	18.3 ± 10.1
Change
At week 8a	−13.7 ± 10.0	−13.6 ± 8.8	−13.7 ± 9.4	−14.2 ± 9.9	−10.7 ± 9.5
Difference from the placebo groupb	−3.0	−2.7	−2.8	−3.2	–
P-valuec	0.018	0.021	0.006	0.009	–
Difference from the paroxetine groupd	0.3 (−2.2, 2.8)	0.6 (−1.7, 3.0)	0.5 (−1.6, 2.6)	–	–
P-valuee	0.796	0.612	0.652	–	–

Notes: Both escitalopram administration groups showed significant improvement compared to the placebo group. The upper limit of the 95% confidence interval for the difference between the combined escitalopram groups and the paroxetine group was below the noninferiority margin (3.2); this confirmed the noninferiority of escitalopram to paroxetine.

a Mean ± SD;

b least squares mean;

c versus the placebo group (ANCOVA);

d least squares mean (two-sided 95% confidence interval);

e versus the paroxetine group (ANCOVA). The threshold limit of noninferiority is 3.2. Copyright © 2011, Seiwa Publishers. Adapted with permission from Hirayasu Y. A dose-response and non-inferiority study evaluating the efficacy and safety of escitalopram in patients with major depressive disorder: a placebo- and paroxetine-controlled, double-blind, comparative study. Jpn J Clin Psychopharmacol. 2011;14:883–899.²⁶

Abbreviations: ANCOVA, analysis of covariance; MADRS, Montgomery–Asberg Depression Rating Scale; MDD, major depressive disorder.

Figure 3 Changes in the cumulative non-relapse rate.

Notes: Escitalopram exhibits a low relapse rate, demonstrating a significant relapse-preventing effect compared to placebo. Copyright © 2007, Wolters Kluwer Health. Adapted with permission from Gorwood P, Weiller E, Lemming O, Katona C. Escitalopram prevents relapse in older patients with major depressive disorder. Am J Geriatr Psychiatry. 2007;15(7):581–593.³⁷

Figure 4 Discontinuation Emergent Signs and Symptoms (DESS 47) scores in the post-therapy observation period.

Copyright © 2006, Lippincott Williams & Wilkins. Adapted with permission from Baldwin DS, Cooper JA, Huusom AK, Hindmarch I. A double-blind, randomized, parallel-group, flexible-dose study to evaluate the tolerability, efficacy and effects of treatment discontinuation with escitalopram and paroxetine in patients with major depressive disorder. Int Clin Psychopharmacol. 2006;21(3):159–169.²⁵

Notes: The change in the total modified DESS 47 score was calculated from the beginning of post-therapy observation to the end of one week with either alternate-day dosing or placebo. The mean scores are indicated in the bars. Scores were −0.02 for the escitalopram group and 1.28 for the paroxetine group. The corresponding values at 1 week of placebo administration were 1.63 for the escitalopram group and 3.42 for the paroxetine group. Significantly fewer post-therapy symptoms were observed in the escitalopram group than in the paroxetine group at all times.

Figure 5 Efficacy and patient acceptability of new antidepressant drugs.

Notes: The odds ratios (OR) of acceptability and efficacy were based on a value of 1 for fluoxetine. Acceptability of escitalopram was highest among the new antidepressant drugs examined. Copyright © 2009, The Family Physician’s Inquiries Network (FPIN). Adapted with permission from Patrick G, Combs G, Gavagan T. Initiating antidepressant therapy? Try these 2 drugs first. J Fam Pract. 2009;58(7):365–369.⁵²
Abbreviation: OR, odds ratio.

KleinNSacherJGeiss-GranadiaTHigher serotonin transporter occupancy after multiple dose administration of escitalopram compared to citalopram: an [123I]ADAM SPECT studyPsychopharmacology (Berl)2007191233333917235610

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HirayasuYA dose-response and non-inferiority study evaluating the efficacy and safety of escitalopram in patients with major depressive disorder: a placebo- and paroxetine-controlled, double-blind, comparative studyJpn J Clin Psychopharmacol201114883899

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GorwoodPWeillerELemmingOKatonaCEscitalopram prevents relapse in older patients with major depressive disorderAm J Geriatr Psychiatry200715758159317586783

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BaldwinDSCooperJAHuusomAKHindmarchIA double-blind, randomized, parallel-group, flexible-dose study to evaluate the tolerability, efficacy and effects of treatment discontinuation with escitalopram and paroxetine in patients with major depressive disorderInt Clin Psychopharmacol200621315916916528138

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PatrickGCombsGGavaganTInitiating antidepressant therapy? Try these 2 drugs firstJ Fam Pract200958736536919607774

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