Hostname: page-component-848d4c4894-m9kch Total loading time: 0 Render date: 2024-05-10T23:49:23.627Z Has data issue: false hasContentIssue false
  • English
  • Français

Escitalopram Versus SNRI Antidepressants in the Acute Treatment of Major Depressive Disorder: Integrative Analysis of Four Double-Blind, Randomized Clinical Trials

Published online by Cambridge University Press:  07 November 2014

Susan G. Kornstein ,
Dayong Li ,
Yongcai Mao ,
Sara Larsson ,
Henning F. Andersen  and
George I. Papakostas
Get access Rights & Permissions [Opens in a new window]

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 ≥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.

Type
Original Research
Information
CNS Spectrums , Volume 14 , Issue 6 , June 2009 , pp. 326 - 333
Copyright
Copyright © Cambridge University Press 2009

Access options

Get access to the full version of this content by using one of the access options below. (Log in options will check for institutional or personal access. Content may require purchase if you do not have access.)

References

REFERENCES

1.Moussavi, S, Chatterji, S, Verdes, E, Tandon, A, Patel, V, Ustun, B. Depression, chronic diseases, and decrements in health: results from the World Health Surveys. Lancet. 2007;370:851–858.Google Scholar
2.Thase, ME. Treatment of severe depression. J Clin Psychiatry. 2000;61(Suppl 1):17–25.Google Scholar
3.Thase, ME. Therapeutic alternatives for difficult-to-treat depression: a narrative review of the state of the evidence. CNS Spectr. 2004;9:808–816, 818–821.CrossRefGoogle ScholarPubMed
4.Papakostas, GI, Fava, M. Monoaminergic-based pharmacotherapy for depression. In: Licinio, J, Wong, ML, eds. Biology of Depression: From Novel Insights to Therapeutic Strategies. 1st ed. Weinheim, Germany: Wiley-VCH; 2005:87–140.Google Scholar
5.Lam, RW, Andersen, HF. The influence of baseline severity on efficacy of escitalopram and citalopram in the treatment of major depressive disorder: an extended analysis. Pharmacopsychiatry. 2006;39:180–184.Google Scholar
6.Moore, N, Verdoux, H, Fantino, B. Prospective, multicentre, randomized, double-blind study of the efficacy of escitalopram versus citalopram in outpatient treatment of major depressive disorder. Int Clin Psychopharmacol. 2005;20:131–137.Google Scholar
7.Boulenger, JP, Huusom, AK, Florea, I, Baekdal, T, Sarchiapone, M. A comparative study of the efficacy of long-term treatment with escitalopram and paroxetine in severely depressed patients. Curr Med Res Opin. 2006;22:1331–1341.Google Scholar
8.Kennedy, SH, Andersen, HF, Lam, RW. Efficacy of escitalopram in the treatment of major depressive disorder compared with conventional selective serotonin reuptake inhibitors and venlafaxine XR: a meta-analysis. J Psychiatry Neurosci. 2006;31:122–131.Google Scholar
9.Nemeroff, CB, Entsuah, R, Benattia, I, Demitrack, M, Sloan, DM, Thase, ME. Comprehensive analysis of remission (COMPARE) with venlafaxine versus SSRIs. Biol Psychiatry. 2008;63:424–434.Google Scholar
10.Papakostas, GI, Fava, M, Thase, ME. Treatment of SSRI-resistant depression: a meta-analysis comparing within- versus across-class switches. Biol Psychiatry. 2008;63:699–704.Google Scholar
11.Papakostas, GI, Thase, ME, Fava, M, Nelson, JC, Shelton, RC. Are antidepressant drugs that combine serotonergic and noradrenergic mechanisms of action more effective than the selective serotonin reuptake inhibitors in treating major depressive disorder? A meta-analysis of studies of newer agents. Biol Psychiatry. 2007;62:1217–1227.CrossRefGoogle Scholar
12.Thase, ME. Are SNRIs More Effective than SSRIs? A Review of the Current State of the Controversy. Psychopharmacol Bull. 2008;41:58–85.Google Scholar
13.Thase, ME, Entsuah, AR, Rudolph, RL. Remission rates during treatment with venlafaxine or selective serotonin reuptake inhibitors. Br J Psychiatry. 2001;178:234–241.Google Scholar
14.Bielski, RJ, Ventura, D, Chang, CC. A double-blind comparison of escitalopram and venlafaxine extended release in the treatment of major depressive disorder. J Clin Psychiatry. 2004;65:1190–1196.Google Scholar
15.Khan, A, Bose, A, Alexopoulos, GS, Gommoll, C, Li, D, Gandhi, C. Double-blind comparison of escitalopram and duloxetine in the acute treatment of major depressive disorder. Clin Drug Investig. 2007;27:481–492.Google Scholar
16.Montgomery, SA, Huusom, AK, Bothmer, J. A randomised study comparing escitalopram with venlafaxine XR in primary care patients with major depressive disorder. Neuropsychobiology. 2004;50:57–64.Google Scholar
17.Nierenberg, AA, Greist, JH, Mallinckrodt, CH, et al.Duloxetine versus escitalopram and placebo in the treatment of patients with major depressive disorder: onset of antidepressant action, a non-inferiority study. Curr Med Res Opin. 2007;23:401–416.CrossRefGoogle Scholar
18.Wade, A, Gembert, K, Florea, I. A comparative study of the efficacy of acute and continuation treatment with escitalopram versus duloxetine in patients with major depressive disorder. Curr Med Res Opin. 2007;23:1605–1614.Google Scholar
19.Lieberman, JA, Greenhouse, J, Hamer, RM, et al.Comparing the effects of antidepressants: consensus guidelines for evaluating quantitative reviews of antidepressant efficacy. Neuropsychopharmacology. 2005;30:445–460.Google Scholar
20.Khan, A, Brodhead, AE, Kolts, RL, Brown, WA. Severity of depressive symptoms and response to antidepressants and placebo in antidepressant trials. J Psychiatr Res. 2005;39:145–150.Google Scholar
21.Diagnostic and Statistical Manual of Mental Disorders, 4th ed, text rev. Washington, DC: American Psychiatric Association; 2000.Google Scholar
22.Montgomery, SA, Å M. A new depression scale designed to be sensitive to change. Br J Psychiatry. 1979;134:382–389.Google Scholar
23.Owens, MJ, Knight, DL, Nemeroff, CB. Second-generation SSRIs: human monoamine transporter binding profile of escitalopram and R-fluoxetine. Biol Psychiatry. 2001;50:345–350.Google Scholar
24.Thase, ME, Pritchett, YL, Ossanna, MJ, Swindle, RW, Xu, J, Detke, MJ. Efficacy of duloxetine and selective serotonin reuptake inhibitors: comparisons as assessed by remission rates in patients with major depressive disorder. J Clin Psychopharmacol. 2007;27:672–676.Google Scholar
25. Paxil [package insert]. Research Triangle Park, NC: GlaxoSmithKline; 2009.Google Scholar
26. Prozac [package insert]. Indianapolis, IN: Eli Lilly and Company; 2009.Google Scholar
27. Cymbalta [package insert]. Indianapolis, IN: Eli Lilly and Company; 2009.Google Scholar
28.Lam, RW, Andersen, HF, Wade, AG. Escitalopram and duloxetine in the treatment of major depressive disorder: a pooled analysis of two trials. Int Clin Psychopharmacol. 2008;23:181–187.Google Scholar
29.Montgomery, SA, Andersen, HF. Escitalopram versus venlafaxine XR in the treatment of depression. Int Clin Psychopharmacol. 2006;21:297–309.Google Scholar
30.Perahia, DG, Pritchett, YL, Kajdasz, DK, et al.A randomized, double-blind comparison of duloxetine and venlafaxine in the treatment of patients with major depressive disorder. J Psychiatr Res. 2008;42:22–34.CrossRefGoogle ScholarPubMed
31.Bech, P, Kajdasz, DK, Porsdal, V. Dose-response relationship of duloxetine in placebo-controlled clinical trials in patients with major depressive disorder. Psychopharmacology (Berl). 2006;188:273–280.Google Scholar
32.Pritchett, YL, Marciniak, MD, Corey-Lisle, PK, Berzon, RA, Desaiah, D, Detke, MJ. Use of effect size to determine optimal dose of duloxetine in major depressive disorder. J Psychiatr Res. 2007;41:311–318.Google Scholar
33.Kornstein, SG, Dunner, DL, Meyers, AL, et al.A randomized, double-blind study of increasing or maintaining duloxetine dose in patients without remission of major depressive disorder after initial duloxetine therapy. J Clin Psychiatry. 2008;69:1383–1392.CrossRefGoogle ScholarPubMed
34.Pigott, TA, Prakash, A, Arnold, LM, Aaronson, ST, Mallinckrodt, CH, Wohlreich, MM. Duloxetine versus escitalopram and placebo: an 8-month, double-blind trial in patients with major depressive disorder. Curr Med Res Opin. 2007;23:1303–1318.Google Scholar