More Comparisons
Acyclovir
Amitriptyline
Amoxicillin
Augmentin
Azithromycin
Bupropion
Carisoprodol
Cefuroxime
Cephalexin
Citalopram
Ciprofloxacin
Cyclobenzaprine
Doxycycline
Duloxetine
Escitalopram
Finasteride
Fluoxetine
Gabapentin
Levofloxacin
Linezolid
Metronidazole
Minocycline
Nabumetone
Orlistat
Paroxetine
Penicillin
Sertraline
Topiramate
Tramadol
Trazodone
Valacyclovir
Venlafaxine

Duloxetine (Cymbalta) versus...

Duloxetine (Cymbalta) vs. Escitalopram (Lexapro)

Major depressive disorder

Escitalopram may be superior to duloxetine in acute treatment and at least as efficacious and better tolerated in long-term treatment of major depressive disorder1. Withdrawal due to the side effects occurs more frequently with duloxetine treatment3.

Results of comparative study of escitalopram versus duloxetine in major depressive disorder1
Duloxetine
Escitalopram
Regimen 60 mg/day for 24 weeks 20 mg/day for 24 weeks
Mean change from baseline in total MADRS score at week 8
-17.4
-19.5
Proportion of responders at week 8
58%
69%
Mean change from baseline in total MADRS score at week 24
-21.7
-23.4
Withdrawal rates due to adverse events
17%
9%
Adverse events:
- insomnia
- constipation

12.6%
8.6%

4.9%
2.8%


Results of randomized, double-blind, placebo-controlled trial in patients with major depressive disorder2
Duloxetine
Escitalopram
Regimen 120 mg/day for 8 months 20 mg/day for 8 months
Probability of remission at 8 months
70%
75%
Sleep improvement   escitalopram had a statistically significant advantage over duloxetine in improving sleep.
Rates of discontinuation due to adverse events
12.8%
12.0%
Adverse events tended to emerge early in treatment (e.g., nausea, dry mouth) tended to emerge later in treatment (e.g., diarrhea, weight increase)
Mean changes from baseline to study endpoint for:
pulse


+3.05 beats per minute


-0.89 beats per minute
systolic blood pressure +3.73 mmHg +0.31 mmHg
diastolic blood pressure +0.81 -0.24
Change in weight +0.61 kg +1.83 kg

Duloxetine (Cymbalta) vs. Paroxetine (Paxil)

Major depressive disorder

In clinical study duloxetine treated patients (80 and 120 mg/day) showed significantly greater improvement in the HAMD(17) total score at week 8 compared with placebo. Paroxetine was not significantly different from placebo on mean change on the HAMD(17). Duloxetine 120 mg/day also showed significant improvement on most secondary efficacy measures (six of nine) compared with placebo while duloxetine 80 mg/day (three of nine) and paroxetine (three of nine) were significantly superior to placebo on fewer secondary measures. Both duloxetine doses met statistical criteria for non-inferiority to paroxetine 4.

Side effects

Nausea occurs more frequently with duloxetine. The incidence of sexual dysfunction is significantly higher with paroxetine 5. Insomnia occurs significantly more frequently with duloxetine than with paroxetine (19.8% vs. 8.0% for paroxetine respectively) 6.

Further reading
References
  • 1. 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 Jul;23(7):1605-14. PubMed
  • 2. 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 Apr 27. PubMed
  • 3. 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(7):481-92. PubMed
  • 4. Perahia DG, Wang F, Mallinckrodt CH, Walker DJ, Detke MJ. Duloxetine in the treatment of major depressive disorder: a placebo- and paroxetine-controlled trial. Eur Psychiatry. 2006 Sep;21(6):367-78. Epub 2006 May 11. PubMed
  • 5. Delgado PL, Brannan SK, Mallinckrodt CH, Tran PV, McNamara RK, Wang F, Watkin JG, Detke MJ. Sexual functioning assessed in 4 double-blind placebo- and paroxetine-controlled trials of duloxetine for major depressive disorder. J Clin Psychiatry. 2005 Jun;66(6):686-92. PubMed
  • 6. Goldstein DJ, Lu Y, Detke MJ, Wiltse C, Mallinckrodt C, Demitrack MA. Duloxetine in the treatment of depression: a double-blind placebo-controlled comparison with paroxetine. J Clin Psychopharmacol. 2004 Aug;24(4):389-99. PubMed

Published: March 31, 2008
Last updated: March 24, 2014

Advertisement