Escitalopram Vs Duloxetine in Acute Treatment of Major Depressive Disorder: Meta-analysis and Systematic Review

Overview

Journal Neuropsychiatr Dis Treat

Publisher Dove Medical Press

Specialty Psychiatry

Date 2018 Aug 21

PMID 30122927

Citations 3

Authors

Benchalak Maneeton

Narong Maneeton

Surinporn Likhitsathian

Pakapan Woottiluk

Punjaree Wiriyacosol

Vudhichai Boonyanaruthee

Manit Srisurapanont

Affiliations

Soon will be listed here.

Abstract

Background: Previous evidence indicated that efficacy of escitalopram (Esc) and duloxetine (Dul) was comparable in the treatment of major depressive disorder (MDD). Since such studies had small sample sizes, this study purposefully applied a systematic review to determine the efficacy, acceptability, and tolerability those antidepressants in treatment of MDD.

Participants And Methods: The following primary databases were searched in July 2017: Scopus, PubMed, CINAHL, and Cochrane Controlled Trials Register. Any randomized controlled trials (RCTs) of Esc comparison with Dul in the treatment of MDD were included in this review. The primary efficacy of outcome was the pooled mean-changed scores of the rating scales for the standardized rating scales for depression.

Results: A total of 1,120 randomized subjects from 3 RCTs were collected for synthesis in the present meta-analysis. The mean-changed scores of the Hamilton Depression Rating Scale (HAMD) and Clinical Global Impression - Severity, overall response rate by the HAMD, and remission rate by the HAMD and Montgomery-Asberg Depression Rating Scale (MADRS) in the Esc- and Dul-treated groups showed no significant differences. However, the mean-changed score of the MARDS, mean-end scores of Clinical Global Impression - Improvement, and overall response by the MADRS in the Esc-treated group were greater than that of the Dul-treated group. Although the overall discontinuation rate had no significant differences between the 2 groups, the discontinuation rate due to adverse events in the Esc-treated group was greater than that of the Dul-treated group.

Limitations: This review had limited eligible studies.

Conclusion: This review indicated the efficacy in the acute treatment of Esc vs Dul varied relying on measurements across the studies. However, the tolerability of Esc was superior to Dul in acute MDD treatment. Therefore, selection between the 2 antidepressants may depend on the tolerability of MDD patients. Due to limited included studies in this review, more large-scale and well-defined RCTs in such patients should be carried out to determine these outcomes.

Citing Articles

Escitalopram versus other antidepressive agents for major depressive disorder: a systematic review and meta-analysis.

Yin J, Song X, Wang C, Lin X, Miao M BMC Psychiatry. 2023; 23(1):876.

PMID: 38001423 PMC: 10675869. DOI: 10.1186/s12888-023-05382-8.

Efficacy and Safety of Escitalopram Oral Drops to Treat Major Depressive Disorder and Generalized Anxiety Disorder in Adolescent, Adult and Geriatric Patients: A Prospective Multicenter Observational Study in Pakistan.

Afridi M, Dogar I, Nizami A, Aslam R, Mustafa A, Syed Muhammad S Cureus. 2020; 12(1):e6792.

PMID: 32140351 PMC: 7046010. DOI: 10.7759/cureus.6792.

Repetitive Transcranial Magnetic Stimulation Combined with Antidepressants for the First Episode of Major Depressive Disorder.

Maneeton B, Maneeton N, Woottiluk P, Likhitsathian S Curr Neuropharmacol. 2020; 18(9):852-860.

PMID: 32091338 PMC: 7569318. DOI: 10.2174/1570159X18666200221113134.

References

Wiebe N, Vandermeer B, Platt R, Klassen T, Moher D, Barrowman N . A systematic review identifies a lack of standardization in methods for handling missing variance data. J Clin Epidemiol. 2006; 59(4):342-53. DOI: 10.1016/j.jclinepi.2005.08.017. View

Romera I, Perez V, Menchon J, Schacht A, Papen R, Neuhauser D . Early switch strategy in patients with major depressive disorder: a double-blind, randomized study. J Clin Psychopharmacol. 2012; 32(4):479-86. DOI: 10.1097/JCP.0b013e31825d9958. View

Khan A, Bose A, Alexopoulos G, 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(7):481-92. DOI: 10.2165/00044011-200727070-00005. View

Cipriani A, Koesters M, Furukawa T, Nose M, Purgato M, Omori I . Duloxetine versus other anti-depressive agents for depression. Cochrane Database Syst Rev. 2012; 10:CD006533. PMC: 4169791. DOI: 10.1002/14651858.CD006533.pub2. View

Nierenberg A, Greist J, Mallinckrodt C, Prakash A, Sambunaris A, Tollefson G . 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(2):401-16. DOI: 10.1185/030079906X167453. View

Raskin J, George T, Granger R, Hussain N, Zhao G, Marangell L . Apathy in currently nondepressed patients treated with a SSRI for a major depressive episode: outcomes following randomized switch to either duloxetine or escitalopram. J Psychiatr Res. 2012; 46(5):667-74. DOI: 10.1016/j.jpsychires.2012.02.010. View

Cipriani A, Furukawa T, Salanti G, Geddes J, Higgins J, Churchill R . Comparative efficacy and acceptability of 12 new-generation antidepressants: a multiple-treatments meta-analysis. Lancet. 2009; 373(9665):746-58. DOI: 10.1016/S0140-6736(09)60046-5. View

Steffens D, Krishnan K, Helms M . Are SSRIs better than TCAs? Comparison of SSRIs and TCAs: a meta-analysis. Depress Anxiety. 1997; 6(1):10-8. DOI: 10.1002/(sici)1520-6394(1997)6:1<10::aid-da2>3.0.co;2-9. View

Papakostas G . Tolerability of modern antidepressants. J Clin Psychiatry. 2008; 69 Suppl E1:8-13. View

10.

Bostwick J, Pankratz V . Affective disorders and suicide risk: a reexamination. Am J Psychiatry. 2000; 157(12):1925-32. DOI: 10.1176/appi.ajp.157.12.1925. View

11.

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(7):1605-14. DOI: 10.1185/030079907x210732. View

12.

Pigott T, Prakash A, Arnold L, Aaronson S, Mallinckrodt C, Wohlreich M . Duloxetine versus escitalopram and placebo: an 8-month, double-blind trial in patients with major depressive disorder. Curr Med Res Opin. 2007; 23(6):1303-18. DOI: 10.1185/030079907X188107. View

13.

Anderson I . Meta-analytical studies on new antidepressants. Br Med Bull. 2001; 57:161-78. DOI: 10.1093/bmb/57.1.161. View

14.

Papakostas G, Homberger C, Fava M . A meta-analysis of clinical trials comparing mirtazapine with selective serotonin reuptake inhibitors for the treatment of major depressive disorder. J Psychopharmacol. 2008; 22(8):843-8. DOI: 10.1177/0269881107083808. View

15.

Maneeton N, Maneeton B, Eurviriyanukul K, Srisurapanont M . Efficacy, tolerability, and acceptability of bupropion for major depressive disorder: a meta-analysis of randomized-controlled trials comparison with venlafaxine. Drug Des Devel Ther. 2013; 7:1053-62. PMC: 3790834. DOI: 10.2147/DDDT.S46849. View

16.

Cohen R, Greenberg J, IsHak W . Incorporating multidimensional patient-reported outcomes of symptom severity, functioning, and quality of life in the Individual Burden of Illness Index for Depression to measure treatment impact and recovery in MDD. JAMA Psychiatry. 2013; 70(3):343-50. DOI: 10.1001/jamapsychiatry.2013.286. View

17.

Schueler Y, Koesters M, Wieseler B, Grouven U, Kromp M, Kerekes M . A systematic review of duloxetine and venlafaxine in major depression, including unpublished data. Acta Psychiatr Scand. 2010; 123(4):247-65. DOI: 10.1111/j.1600-0447.2010.01599.x. View

18.

Schmitt A, Bauer M, Volz H, Moeller H, Jiang Q, Ninan P . Differential effects of venlafaxine in the treatment of major depressive disorder according to baseline severity. Eur Arch Psychiatry Clin Neurosci. 2009; 259(6):329-39. DOI: 10.1007/s00406-009-0003-7. View

19.

Mallinckrodt C, Prakash A, Houston J, Swindle R, Detke M, Fava M . Differential antidepressant symptom efficacy: placebo-controlled comparisons of duloxetine and SSRIs (fluoxetine, paroxetine, escitalopram). Neuropsychobiology. 2007; 56(2-3):73-85. DOI: 10.1159/000111537. View

20.

Yilmaz A . [Examination of the Metacognitive Model of Depression in a Turkish University Student Sample]. Turk Psikiyatri Derg. 2016; 27(2). View