Is Escitalopram Really Relevantly Superior to Citalopram in Treatment of Major Depressive Disorder? A Meta-analysis of Head-to-head Randomized Trials

Overview

Journal Croat Med J

Specialty General Medicine

Date 2010 Feb 18

PMID 20162747

Citations 5

Authors

Vladimir Trkulja

Affiliations

Soon will be listed here.

Abstract

Aim: To evaluate clinical relevance of differences between escitalopram and citalopram (equimolar) for major depressive disorder.

Methods: Review and meta-analysis of comparative randomized controlled trials (RCT). Comparisons were in relation to Montgomery-Asberg depression rating scale (MADRS) score reduction at weeks 1 (5 RCTs), 4 (5 RCTs), 6 (4 RCTs), 8 (5 RCTs), and 24 (1 RCT); proportion of responders at weeks 2, 4, 6 (2 RCTs for each time point), 8 (5 RCTs), and 24 (1 RCT); clinical global impression-severity (CGI-S) reduction at weeks 6 (1 RCT), 8 (5 RCTs), and 24 (1 RCT), and discontinuation due to adverse events or inefficacy during short-term (up to 8 weeks) and medium-term (24 weeks) treatment.

Results: MADRS reduction was greater with escitalopram, but 95% confidence intervals (CI) around the mean difference were entirely or largely below 2 scale points (minimally important difference) and CI around the effect size (ES) was below 0.32 ("small") at all time points. Risk of response was higher with escitalopram at week 8 (relative risk, 1.14; 95% CI, 1.04 to 1.26) but number needed to treat was 14 (95% CI, 7 to 111). All 95% CIs around the mean difference and ES of CGI-S reduction at week 8 were below 0.32 points and the limit of "small," respectively. Data for severe patients (MADRS> or =30) are scarce (only 1 RCT), indicating somewhat greater efficacy (response rate and MADRS reduction at week 8, but not CGI-S reduction) of escitalopram, but without compelling evidence of clinically relevant differences. Discontinuations due to adverse events or inefficacy up to 8 weeks of treatment were comparable. Data for the period up to 24 weeks are scarce and inconclusive.

Conclusion: Presently, the claims about clinically relevant superiority of escitalopram over citalopram in short-to-medium term treatment of major depressive disorder are not supported by evidence.

Citing Articles

What is the vibration of effects?.

Vinatier C, Hoffmann S, Patel C, DeVito N, Cristea I, Tierney B BMJ Evid Based Med. 2024; 30(1):61-65.

PMID: 38997151 PMC: 11874424. DOI: 10.1136/bmjebm-2023-112747.

Double blind, randomised trial to compare efficacy of escitalopram versus citalopram for interferon induced depression in hepatitis C patients.

Shakeel U, Shamim S, Azam Z, Arshad H, Asgher A Contemp Clin Trials Commun. 2020; 19:100622.

PMID: 32760848 PMC: 7390792. DOI: 10.1016/j.conctc.2020.100622.

Can antidepressants prevent pegylated interferon-α/ribavirin-associated depression in patients with chronic hepatitis C: meta-analysis of randomized, double-blind, placebo-controlled trials?.

Hou X, Xu J, Wang J, Yu Y PLoS One. 2013; 8(10):e76799.

PMID: 24204676 PMC: 3813681. DOI: 10.1371/journal.pone.0076799.

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

Kirino E Patient Prefer Adherence. 2012; 6:853-61.

PMID: 23271894 PMC: 3526882. DOI: 10.2147/PPA.S22495.

Comparative efficacy of escitalopram in the treatment of major depressive disorder.

Ali M, Lam R Neuropsychiatr Dis Treat. 2011; 7:39-49.

PMID: 21430793 PMC: 3056172. DOI: 10.2147/NDT.S12531.

References

Busner J, Targum S, Miller D . The Clinical Global Impressions scale: errors in understanding and use. Compr Psychiatry. 2009; 50(3):257-62. DOI: 10.1016/j.comppsych.2008.08.005. View

Turner E, Matthews A, Linardatos E, Tell R, Rosenthal R . Selective publication of antidepressant trials and its influence on apparent efficacy. N Engl J Med. 2008; 358(3):252-60. DOI: 10.1056/NEJMsa065779. View

Sanchez C, Bogeso K, Ebert B, Reines E, Braestrup C . Escitalopram versus citalopram: the surprising role of the R-enantiomer. Psychopharmacology (Berl). 2004; 174(2):163-76. DOI: 10.1007/s00213-004-1865-z. View

Burke W, Gergel I, Bose A . Fixed-dose trial of the single isomer SSRI escitalopram in depressed outpatients. J Clin Psychiatry. 2002; 63(4):331-6. DOI: 10.4088/jcp.v63n0410. View

Friedrich J, Adhikari N, Beyene J . Inclusion of zero total event trials in meta-analyses maintains analytic consistency and incorporates all available data. BMC Med Res Methodol. 2007; 7:5. PMC: 1783664. DOI: 10.1186/1471-2288-7-5. View

Schwan S, Hallberg P . [Escitalopram versus citalopram in true depression. Review of studies do not support clinically relevant differences of the effect]. Lakartidningen. 2009; 106(12):858-61. View

Hamilton M . A rating scale for depression. J Neurol Neurosurg Psychiatry. 1960; 23:56-62. PMC: 495331. DOI: 10.1136/jnnp.23.1.56. View

Colonna L, Andersen H, Reines E . A randomized, double-blind, 24-week study of escitalopram (10 mg/day) versus citalopram (20 mg/day) in primary care patients with major depressive disorder. Curr Med Res Opin. 2005; 21(10):1659-68. DOI: 10.1185/030079905X65484. View

Kadouri A, Corruble E, Falissard B . The improved Clinical Global Impression Scale (iCGI): development and validation in depression. BMC Psychiatry. 2007; 7:7. PMC: 1802073. DOI: 10.1186/1471-244X-7-7. View

10.

Ioannidis J . Effectiveness of antidepressants: an evidence myth constructed from a thousand randomized trials?. Philos Ethics Humanit Med. 2008; 3:14. PMC: 2412901. DOI: 10.1186/1747-5341-3-14. View

11.

Ioannidis J . Ranking antidepressants. Lancet. 2009; 373(9677):1759-60. DOI: 10.1016/S0140-6736(09)60974-0. View

12.

Yevtushenko V, Belous A, Yevtushenko Y, Gusinin S, Buzik O, Agibalova T . Efficacy and tolerability of escitalopram versus citalopram in major depressive disorder: a 6-week, multicenter, prospective, randomized, double-blind, active-controlled study in adult outpatients. Clin Ther. 2007; 29(11):2319-32. DOI: 10.1016/j.clinthera.2007.11.014. View

13.

Svensson S, Mansfield P . Escitalopram: superior to citalopram or a chiral chimera?. Psychother Psychosom. 2003; 73(1):10-6. DOI: 10.1159/000074435. View

14.

Kennedy S, Andersen H, Lam R . 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(2):122-31. PMC: 1413963. View

15.

Gartlehner G, Gaynes B, Hansen R, Thieda P, DeVeaugh-Geiss A, Krebs E . Comparative benefits and harms of second-generation antidepressants: background paper for the American College of Physicians. Ann Intern Med. 2008; 149(10):734-50. DOI: 10.7326/0003-4819-149-10-200811180-00008. View

16.

Llorca P, Azorin J, Despiegel N, Verpillat P . Efficacy of escitalopram in patients with severe depression: a pooled analysis. Int J Clin Pract. 2005; 59(3):268-75. DOI: 10.1111/j.1742-1241.2005.00440.x. View

17.

Murdoch D, Keam S . Spotlight on escitalopram in the management of major depressive disorder. CNS Drugs. 2006; 20(2):167-70. DOI: 10.2165/00023210-200620020-00007. View

18.

Montgomery S, Moller H . Is the significant superiority of escitalopram compared with other antidepressants clinically relevant?. Int Clin Psychopharmacol. 2009; 24(3):111-8. DOI: 10.1097/YIC.0b013e32832a8eb2. View

19.

Montgomery S, Asberg M . A new depression scale designed to be sensitive to change. Br J Psychiatry. 1979; 134:382-9. DOI: 10.1192/bjp.134.4.382. View

20.

Furukawa T, Barbui C, Cipriani A, Brambilla P, Watanabe N . Imputing missing standard deviations in meta-analyses can provide accurate results. J Clin Epidemiol. 2005; 59(1):7-10. DOI: 10.1016/j.jclinepi.2005.06.006. View