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Pharmacopsychiatry 2007; 40(1): 20-24
DOI: 10.1055/s-2007-958718
Original Paper

© Georg Thieme Verlag KG Stuttgart · New York

Escitalopram in Seasonal Affective Disorder: Results of an Open Trial

E. Pjrek 1 , D. Winkler 1 , J. Stastny 1 , N. Praschak-Rieder 1 , M. Willeit 1 , S. Kasper 1
  • 1Department of General Psychiatry, Medical University of Vienna, Vienna, Austria
Further Information

Publication History

received 8. 8. 2006 revised 13. 11. 2006

accepted 13. 11. 2006

Publication Date:
27 February 2007 (online)

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Objective: The aim of this study was to evaluate the efficacy and tolerability of escitalopram in the treatment of seasonal affective disorder (SAD, fall-winter depression).

Methods: Twenty SAD patients were included in an 8-week drug surveillance. Patients were treated with open-label escitalopram at a dosage of 10 to 20 mg per day. Efficacy assessments included the Structured Interview Guide for the Hamilton Depression Rating Scale (SAD version; SIGH-SAD), the Clinical Global Impression (CGI) and the Social Adaptation Self Evaluation Scale (SASS). Side effects were monitored with the UKU Side Effect Rating Scale.

Results: From week 2 onwards, escitalopram significantly reduced SIGH-SAD score and CGI severity score (p<0.001). From week 4 onwards, the SASS score was also significantly improved (p<0.05). The response rate (SIGH-SAD<50% of baseline value) after treatment for 8 weeks was 95%, the rate of remission (SIGH-SAD ≤7) was 85%. Side effects were mild to moderate and did not lead to cessation of therapy.

Conclusion: These results suggest that escitalopram is an efficacious and altogether safe treatment for seasonal depression.

References

  • 1 American Psychiatric Association .Diagnostic and Statistical Manual of Mental Disorder. 4th edition, text revision (DSM-IV-TR) Washington, DC: American Psychiatric Press 2000
    Google Scholar
  • 2 Bech P. Social functioning: should it become an endpoint in trials of antidepressants?.  CNS Drugs. 2005;  19 313-324
    CrossrefPubMedGoogle Scholar
  • 3 Bech P, Allerup P, Gram LF, Reisby N, Rosenberg R, Jacobsen O. et al . The Hamilton depression scale. Evaluation of objectivity using logistic models.  Acta Psychiatr Scand. 1981;  63 290-299
    CrossrefPubMedGoogle Scholar
  • 4 Bech P, Andersen HF, Wade A. Effective dose of escitalopram in moderate versus severe DSM-IV major depression.  Pharmacopsychiatry. 2006;  39 128-134
    Article in Thieme ConnectPubMedGoogle Scholar
  • 5 Bosc M, Dubini A, Polin V. Development and validation of a social functioning scale, the Social Adaptation Self-evaluation Scale.  Eur Neuropsychopharmacol. 1997;  7 ((Suppl 1)) 57-70 , discussion 71-73
    CrossrefPubMedGoogle Scholar
  • 6 Brambilla P, Cipriani A, Hotopf M, Barbui C. Side-effect profile of fluoxetine in comparison with other SSRIs, tricyclic and newer antidepressants: a meta-analysis of clinical trial data.  Pharmacopsychiatry. 2005;  38 69-77
    Article in Thieme ConnectPubMedGoogle Scholar
  • 7 Bundesgesetzblatt für die Republik Österreich . , Bundesgesetz vom 2. März 1983 über die Herstellung und das Inverkehrbringen von Arzneimitteln (Arzneimittelgesetz). BGBl. Nr. 185/1983
  • 8 Burke WJ, Gergel I, Bose A. Fixed-dose trial of the single isomer SSRI escitalopram in depressed outpatients.  J Clin Psychiatry. 2002;  63 331-336
    CrossrefPubMedGoogle Scholar
  • 9 Chen F, Larsen MB, Sanchez C, Wiborg O. The S-enantiomer of R,S-citalopram, increases inhibitor binding to the human serotonin transporter by an allosteric mechanism. Comparison with other serotonin transporter inhibitors.  Eur Neuropsychopharmacol. 2005;  15 193-198
    CrossrefPubMedGoogle Scholar
  • 10 Ferguson JM. SSRI antidepressant medications: adverse effects and tolerability.  Prim Care Companion J Clin Psychiatry. 2001;  3 22-27
    CrossrefPubMedGoogle Scholar
  • 11 First MB, Spitzer RL, Gibbon M, Williams JB. Structured clinical interview for DSM-IV axis I disorders - patient edition. SCID-I/P, version 2.0. New York, NY: New York State Psychiatric Institute, Biometric Research Department 1996
    Google Scholar
  • 12 Goodman WK, Bose A, Wang Q. Treatment of generalized anxiety disorder with escitalopram: pooled results from double-blind, placebo-controlled trials.  J Affect Disord. 2005;  87 161-167
    CrossrefPubMedGoogle Scholar
  • 13 Guy W. ECDEU assessment manual for psychopharmacology. US Department of Health, Education and Welfare publication (ADM) 76-338. Rockville, MD: National Institute of Mental Health 1976
    Google Scholar
  • 14 Kasper S. Jahreszeit und Befindlichkeit in der Allgemeinbevölkerung.Eine Mehrebenenuntersuchung zur Epidemiologie, Biologie und therapeutischen Beeinflußbarkeit (Lichttherapie) saisonaler Befindlichkeitsschwankungen. Monographien aus dem Gesamtgebiet der Psychiatrie, Bd. 66. Berlin, Heidelberg, New York, Tokyo: Springer 1991
    Google Scholar
  • 15 Kasper S, Rogers LBS, Yancey A, Schulz PM, Skwerer RG, Rosenthal NE. Phototherapy in individuals with and without subsyndromal seasonal affective disorder.  Arch Gen Psychiatry. 1989;  46 837-844
    PubMedGoogle Scholar
  • 16 Kasper S, Spadone C, Verpillat P, Angst J. Onset of action of escitalopram compared with other antidepressants: results of a pooled analysis.  Int Clin Psychopharmacol. 2006;  21 105-110
    CrossrefPubMedGoogle Scholar
  • 17 Kasper S, Stein DJ, Loft H, Nil R. Escitalopram in the treatment of social anxiety disorder: randomised, placebo-controlled, flexible-dosage study.  Br J Psychiatry. 2005;  186 222-226
    CrossrefPubMedGoogle Scholar
  • 18 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
    PubMedGoogle Scholar
  • 19 Klein N, Sacher J, Geiss-Granadia T, Attarbaschi T, Mossaheb N, Lanzenberger R. et al . Multiple Dose Administration of Escitalopram Resulted in a Higher Serotonin Transporter Occupancy than Citalopram: A [I123]ADAM SPECT Study in Healthy Volunteers.  Biol Psychiatry. 2006;  59 ((Suppl 1)) 246
    PubMedGoogle Scholar
  • 20 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
    Article in Thieme ConnectPubMedGoogle Scholar
  • 21 Lam RW, Gorman CP, Michalon M, Steiner M, Levitt AJ, Corral MR. et al . Multicenter, placebo-controlled study of fluoxetine in seasonal affective disorder.  Am J Psychiatry. 1995;  152 1765-1770
    PubMedGoogle Scholar
  • 22 Lam RW, Levitt AJ, Levitan RD, Enns MW, Morehouse R, Michalak EE. et al . The Can-SAD study: a randomized controlled trial of the effectiveness of light therapy and fluoxetine in patients with winter seasonal affective disorder.  Am J Psychiatry. 2006;  163 805-812
    CrossrefPubMedGoogle Scholar
  • 23 Lepola UM, Loft H, Reines EH. Escitalopram (10-20 mg/day) is effective and well tolerated in a placebo-controlled study in depression in primary care.  Int Clin Psychopharmacol. 2003;  18 211-217
    CrossrefPubMedGoogle Scholar
  • 24 Lingjærde O, Ahlfors UG, Bech P, Dencker SJ, Elgen K. The UKU side effect rating scale. A new comprehensive rating scale for psychotropic drugs and a cross-sectional study of side effects in neuroleptic-treated patietns.  Acta Psychiatr Scand. 1987;  76 ((Suppl 334)) 1-100
    PubMedGoogle Scholar
  • 25 Llorca PM, Azorin JM, Despiegel N, Verpillat P. Efficacy of escitalopram in patients with severe depression: a pooled analysis.  Int J Clin Pract. 2005;  59 268-275
    CrossrefPubMedGoogle Scholar
  • 26 Moscovitch A, Blashko CA, Eagles JM, Darcourt G, Thompson C, Kasper S. et al . A placebo-controlled study of sertraline in the treatment of outpatients with seasonal affective disorder.  Psychopharmacolgy (Berl). 2004;  171 390-397
    PubMedGoogle Scholar
  • 27 Neumeister A, Konstantinidis A, Praschak-Rieder N, Willeit M, Hilger E, Stastny J. et al . Monoaminergic function in the pathogenesis of seasonal affective disorder.  Int J Neuropsychopharmacol. 2001;  4 409-420
    PubMedGoogle Scholar
  • 28 O’Sullivan RL, Fava M, Agustin C, Baer L, Rosenbaum JF. Sensitivity of the six-item Hamilton Depression Rating Scale.  Acta Psychiatr Scand. 1997;  95 379-384
    PubMedGoogle Scholar
  • 29 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
    CrossrefPubMedGoogle Scholar
  • 30 Partonen T, Lonnqvist J. Moclobemide and fluoxetine in treatment of seasonal affective disorder.  J Affect Disord. 1996;  41 93-99
    CrossrefPubMedGoogle Scholar
  • 31 Pjrek E, Winkler D, Kasper S. Pharmacotherapy of seasonal affective disorder.  CNS Spectr. 2005;  10 664-669 , quiz 672
    PubMedGoogle Scholar
  • 32 Pjrek E, Winkler D, Stastny J, Konstantinidis A, Heiden A, Kasper S. Bright light therapy in seasonal affective disorder - does it suffice?.  Eur Neuropsychopharmacol. 2004;  14 347-351
    CrossrefPubMedGoogle Scholar
  • 33 Rosenthal NE, Bradt GH, Wehr TA. Seasonal Pattern Assessment Questionnaire. Washington, DC: National Institute of Mental Health 1987
    Google Scholar
  • 34 Rosenthal NE, Sack DA, Gillin JC, Lewy AJ, Goodwin FK, Davenport Y. et al . Seasonal affective disorder: a description of the syndrome and preliminary findings with light therapy.  Arch Gen Psychiatry. 1984;  41 72-80
    PubMedGoogle Scholar
  • 35 Ruhrmann S, Kasper S, Hawellek B, Martinez B, Hoflich G, Nickelsen T. et al . Effects of fluoxetine versus bright light in the treatment of seasonal affective disorder.  Psychol Med. 1998;  28 923-933
    CrossrefPubMedGoogle Scholar
  • 36 Rush AJ, Bose A. Escitalopram in clinical practice: results of an open-label trial in a naturalistic setting.  Depress Anxiety. 2005;  21 26-32
    CrossrefPubMedGoogle Scholar
  • 37 Sanchez C, Bogeso KP, Ebert B, Reines EH, Braestrup C. Escitalopram versus citalopram: the surprising role of the R-enantiomer.  Psychopharmacology. 2004;  174 163-176
    PubMedGoogle Scholar
  • 38 SPSS Inc . , SPSS 12.0 for Windows. Release 12.0. Chicago, IL, USA; 1989-2003
  • 39 Stahl SM, Gergel I, Li D. Escitalopram in the treatment of panic disorder: a randomized, double-blind, placebo-controlled trial.  J Clin Psychiatry. 2003;  64 1322-1327
    PubMedGoogle Scholar
  • 40 Wade A, Michael Lemming O, Bang Hedegaard K. Escitalopram 10 mg/day is effective and well tolerated in a placebo-controlled study in depression in primary care.  Int Clin Psychopharmacol. 2002;  17 95-102
    CrossrefPubMedGoogle Scholar
  • 41 Weissman MM, Olfson M, Gameroff MJ, Feder A, Fuentes M. A comparison of three scales for assessing social functioning in primary care.  Am J Psychiatry. 2001;  158 460-466
    CrossrefPubMedGoogle Scholar
  • 42 Williams JBW, Link MJ, Rosenthal NE, Amira L, Terman M. Structured Interview Guide for the Hamilton Depression Rating Scale - Seasonal Affective Disorder Version, 2002 rev. New York, NY: New York State Psychiatric Institute 2002
    Google Scholar
  • 43 Winkler D, Pjrek E, Iwaki R, Kasper S. The treatment of seasonal affective disorder.  Expert Rev Neurother. 2006;  6 1039-1048
    CrossrefPubMedGoogle Scholar
  • 44 Winkler D, Pjrek E, Klein N, Kasper S. Escitalopram in employed people - Results from an observational study in 2378 patients.  Psychopharmakotherapie. 2006;  13 , in press
    PubMedGoogle Scholar
  • 45 Winkler D, Praschak-Rieder N, Willeit M, Lucht MJ, Hilger E, Konstantinidis A. et al . Saisonal abhängige Depression (SAD) in zwei deutschsprachigen Universitätszentren: Bonn, Wien. Seasonal affective disorder in two German-speaking university centers: Clinical and demographic characteristics (German).  Nervenarzt. 2002;  73 637-643
    CrossrefPubMedGoogle Scholar

Correspondence

E. Pjrek

Department of General Psychiatry

Medical University of Vienna

Währinger Gürtel 18-20

1090 Vienna

Austria

Phone: +43/1/40 400 35 68

Fax: +43/1/40 400 30 99

Email: edda.pjrek@meduniwien.ac.at

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