It has been shown, compared with placebo, to be an effective and well-tolerated treatment for major depressive disorders MDD in both primary and specialist care settings. A recent meta-analysis has found that escitalopram-treated patients showed significant higher response rates and increased mean change from baseline in the Montgomery-Asberg Depression Rating Scale MADRS total scores at weeks 1 and 8 compared with citalopram-treated patients.
Each of these active drugs shares similar safety profiles. Although the efficacy of newer antidepressants has been well established for the treatment of mild-to-moderate depression, there are very few studies concerning severe depression. Objective: To determine if escitalopram is more effective than citalopram in patients with severe depression. A SAD lamp can help alleviate symptoms of seasonal affective disorder. Learn more about SAD lamps, how to use them, features to look for, and products….
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Mental Health. Celexa vs. Lexapro Cost and availability Side effects Drug interactions Warnings Takeaway Introduction Finding the right medication to treat your depression can be difficult. Drug Features. Brand name Celexa Lexapro What is the generic drug? Cost, availability, and insurance. Side effects. Drug interactions. Use with other medical conditions. Talk with your doctor. Read this next. Prozac vs. Lexapro: What to Know About Each. Only one study was not published as a peer-reviewed article study 1 , although the data are reported on the Forest website and these data have been included in previous meta-analyses.
Mean dose Esc, Escitalopram; Cit, citalopram. The overall odds ratio for responders was 1. The responder rates were The corresponding NNT for responder was The differences in responder rates in percentage points for each study are shown in Fig. The remission rates were The corresponding NNT for remission was 5.
The differences in remission rates in percentage points for each study are shown in Fig. This meta-analysis of all the publicly available data indicates that escitalopram has superior efficacy compared to citalopram in the treatment of MDD in a patient population including both moderate and severe disorder. It includes all available studies in MDD that included escitalopram and citalopram treatment arms head-to-head, with an active control, or placebo-controlled and provides further evidence for a statistically significant efficacy advantage of escitalopram over citalopram.
However, a statistically significant difference between two treatments may not reflect clinical benefits that are evident or relevant when treating individual patients.
Separate tests are usually applied to the data to test if statistical differences are likely to have clinical relevance. There are several approaches to determining clinical relevance. In regulatory terms the most important are the responder analysis, the remitter analysis and the treatment effect the difference between two treatments in the improvement from baseline to endpoint on a standard assessment scale EMEA, The criteria used to establish a clinically relevant difference have almost all been focused on a comparison of drug and placebo.
Comparing differences between two active treatments applying the same criterion used to define a clinically relevant difference on the pivotal scale between active drug and placebo is very stringent, since this means that the difference to placebo of the superior treatment must be at least twice that of the comparator antidepressant.
The studies included in the present meta-analysis included large regulatory studies sponsored by H. Even if no robust conclusions can be drawn from these smaller studies individually, the results are consistent with those from the larger trials. This is an effectiveness study with an open non-randomized design and the bias of the investigator in the choice of treatment and assessment might have influenced the result.
There is some evidence of possible investigator bias in the allocation of patients to different treatments, since the escitalopram group were significantly more severely depressed at baseline than those on citalopram. This might have been a chance finding but it might also reflect the clinical view, which was already current, that escitalopram was a more effective treatment in severe depression. All effectiveness studies are open to these sorts of biases.
Nevertheless, for the sake of completeness, the study was included Anderson, , but was excluded from the meta-analysis of the randomised controlled studies. The overall treatment difference between escitalopram and citalopram was 1.
A direct measure of the clinically relevant difference may be taken from the difference observed between placebo and citalopram. On the basis of an analysis of the positive antidepressant studies submitted to the FDA, Kirsch et al. In the case of citalopram this difference was 1. In a more recent meta-analysis of placebo controlled studies for all antidepressants, including a range of other non-regulatory studies, the reported difference on HAMD 17 was 1.
Since the present analysis included a wide range of non-regulatory studies, a 1. It could therefore be concluded that this difference is clinically relevant. Since the treatment difference between escitalopram and citalopram was 1. The European Medicines Agency EMEA normally uses a responder analysis to determine whether a statistically significant difference is also clinically relevant.
A statistically significant advantage on the responder analysis in favour of an antidepressant compared with placebo is normally considered by the Committee for Medicinal Products for Human Use CMPH to be clinically relevant EMEA, In a review of placebo-controlled antidepressant studies submitted for regulatory approval over a year period, Melander et al. The present analysis of two antidepressants shows a response advantage of 8. These differences translate into NNTs of approximately 12 for response and six for remission.
The treatment effect for citalopram compared to placebo was constant with increasing baseline severity measured on the MADRS, but the effect increased for escitalopram. The advantage for escitalopram over citalopram became greater and was more strikingly clinically relevant in treating patients with increasing severity of depression.
These data confirm that escitalopram has different properties as an antidepressant compared to citalopram. Based on treatment difference, and NNTs derived from response and remission rates, the statistically significant superiority of escitalopram vs. The authors thank D. Simpson H. The authors are entirely responsible for the scientific content of this article. Thomas Hansen is an employee of H. Anderson IM Psychopharmacology , — Google Scholar. Anon Cipralex escitalopram [in Swedish].
Comparison of escitalopram and citalopram efficacy: a meta-analysis. International Journal of Psychiatry in Clinical Practice 7 , — A comparative study of the efficacy of long-term treatment with escitalopram and paroxetine in severely depressed patients.
Current Medical Research and Opinion 22 , — Fixed-dose trial of the single isomer SSRI escitalopram in depressed outpatients. Journal of Clinical Psychiatry 63 , — Current Medical Research and Opinion 21 , — EMEA Note for guidance on clinical investigation of medicinal products in the treatment of depression. European Medicines Agency. Google Preview. Forest Laboratories Accessed 4 January Efficacy comparison of escitalopram and citalopram in the treatment of major depressive disorder: pooled analysis of placebo-controlled trials.
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