Escitalopram (Lexapro) versus Other Antidepressants
Escitalopram (Lexapro) vs. Citalopram (Celexa)
- Major depressive disorder: Escitalopram appears to have
greater efficacy and faster onset of action than citalopram. The lower efficacy of citalopram in the studies is
apparently due to the inhibition of the effect of the S-enantiomer
by the R-enantiomer. Data from randomised clinical trials consistently
show better efficacy with escitalopram than with citalopram, including
higher rates of response and remission, and faster time to depression symptom
Escitalopram may be a cost-saving alternative to citalopram for
the treatment of severe depression 9.
Escitalopram may have a faster onset and greater overall magnitude
of effect than citalopram in improving symptoms of depression and
anxiety in patients with major depressive disorder 10.
Escitalopram has better efficacy in the treatment of severe depression
than citalopram 11.
- Antinociceptive properties: Study findings show that citalopram
given i.p. is a weak antinociceptor, (not mediated through opioid
mechanisms), while escitalopram possesses no antinociceptive properties
when injected i.p. 12.
Escitalopram (Lexapro) vs. Paroxetine (Paxil)
- Major depressive disorder: Escitalopram is significantly more
effective than paroxetine in the long-term treatment of severely depressed
patients 4, 5.
- Generalized anxiety disorder: The results of the study have
shown that escitalopram 10 mg is more efficacious than paroxetine
20 mg for reducing symptoms in people with generalised anxiety disorder
- Side effects: The results of the clinical study have
shown that the frequency of adverse events are higher with paroxetine
vs. escitalopram: overall (88.7% vs. 77.0%), insomnia (25.8% vs. 14.8%),
constipation (14.5% vs. 1.6%), ejaculation disorder (30.0% vs. 14.8%),
anorgasmia (26.2% vs. 5.9%), and decreased libido (22.6% vs. 4.9%).
Conversely, diarrhea and upper respiratory tract infection are higher
with escitalopram than paroxetine (21.3% vs. 8.1%, and 14.8% vs. 4.8%,
- Withdrawal symptoms: Paroxetine treatment is associated
with significantly more discontinuation symptoms than escitalopram
Escitalopram (Lexapro) vs. Sertraline (Zoloft)
Depression: Sertraline and escitalopram have comparable antidepressant
efficacy in the treatment of major depressive disorder 7.
- Side effects: Both are generally well
Escitalopram (Lexapro) vs. Venlafaxine (Effexor)
Major depressive disorder: In the double-blind
comparison there were no significant differences in measures of efficacy
between escitalopram and venlafaxine. Remission rates were 41.2% for
escitalopram and 36.7% for venlafaxine XR. Response rates for the
escitalopram and venlafaxine XR groups were 58.8% and 48.0%, respectively
1. Escitalopram has a faster
onset of antidepressant effects 6.
- Side effects: Escitalopram appears to be significantly
better tolerated than venlafaxine XR 1.
- Withdrawal symptoms: Venlafaxine is associated with significantly
higher rate of discontinuation symptoms than escitalopram 1,
Escitalopram (Lexapro) vs. Duloxetine (Cymbalta)
Escitalopram may be superior to duloxetine in acute treatment and
at least as efficacious and better tolerated in long-term treatment
of major depressive disorder.
Major depressive disorder:
Duloxetine and escitalopram were compared in an 8-month, randomized,
double-blind, placebo-controlled trial in major depressive disorder.
Both drugs demonstrated similar remission rates over the course of
the study, with the probability of remission reaching 70% for duloxetine
(Cymbalta) and 75% for escitalopram (Lexapro). Similar improvement
was observed for both duloxetine and escitalopram on efficacy measures 13.
Escitalopram appears to have a significant advantage over duloxetine
in improving sleep 13.
In recent comparative study of the efficacy of treatment with escitalopram
versus duloxetine at week 8, the proportion of responders was 69%
with escitalopram and 58% with duloxetine. Remission rates were 56%
with escitalopram and 48% with duloxetine 14.
- Side effects and tolerability:
The rate of treatment discontinuation due to side effects is lower
for escitalopram (9%) compared to duloxetine (17%). Insomnia and constipation
occur significantly more frequently with duloxetine than with escitalopram
Duloxetine adverse events tend to emerge early in treatment (e.g.,
nausea, dry mouth), whereas escitalopram adverse events tend to emerge
later in treatment (e.g., diarrhea, weight increase).
In the study duloxetine was associated with a mean increase in pulse of 3.05 beats per minute (bpm), while escitalopram
was associated with a decrease in pulse rate of 0.89 bpm. Also, duloxetine raised systolic blood pressure by 3.73 mmHg,
while escitalopram by 0.31 mmHg only. At 8 months, mean change in weight was significantly higher for escitalopram
compared with duloxetine (+1.83 kg vs +0.61 kg, respectively).
However, the incidence of treatment-emergent abnormal weight gain
(>/= 7% increase in weight from baseline) was similar between drugs
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Published: March 31, 2008
Last updated: April 10, 2012