Escitalopram (Lexapro) vs Paroxetine (Paxil)

Escitalopram (Lexapro) vs. Paroxetine (Paxil)

Major depressive disorder

Escitalopram is more effective than paroxetine in the treatment of severe depression, including depression accompanied by anxiety symptoms 1, 12. Also, escitalopram has superior tolerability when compared with paroxetine. Paroxetine causes a higher rate of weakness, nausea, vomiting, drowsiness, and somnolence2.

Results of randomized double-blind study of escitalopram vs paroxetine in patients with severe depression accompanied by anxiety symptoms 12. Escitalopram Paroxetine
Regimen 20 mg for 24 weeks 40 mg for 24 weeks
Change from baseline in MADRS total scores
-24.2
-21.5
Change from baseline in HAM-A total score
-17.4
-15.1
Premature withdrawal, number of patients
17%
31%
Conclusion: Patients with severe depression accompanied by anxiety symptoms responded significantly better to escitalopram compared with paroxetine.


Results of comparative study of the efficacy of long-term treatment with escitalopram and paroxetine in severely depressed patients 1. Escitalopram Paroxetine
Regimen 20 mg for 24 weeks 40 mg for 24 weeks
Mean change from baseline in MADRS total score at 24 weeks
-25.2
-23.1
Proportion of remitters after 24 weeks
75%
67%
Withdrawal rate
19%
32%
Withdrawal rate due to adverse events
8%
16%
Conclusion: Escitalopram is significantly more effective than paroxetine in the long-term treatment of severely depressed patients.


Generalized anxiety disorder

Escitalopram is more effective than paroxetine for generalized anxiety disorder13, 14.

Results of randomized double-blind comparison of escitalopram and paroxetine in the long-term treatment of generalized anxiety disorder14. Escitalopram Paroxetine
Regimen 10-20 mg/day for 24 weeks 20-50 mg for 24 weeks
Baseline HAMA scores
23.7
23.4
Mean changes in HAMA scores
-15.3
-13.3
Withdrawal rate due to adverse events
6.6%
22.6%
Overall rate of adverse events
77.0%
88.7%
insomnia
14.8%
25.8%
constipation
1.6%
14.5%
ejaculation disorder
14.8%
30.0%
anorgasmia
5.9%
26.2%
decreased libido
4.9%
22.6%
diarrhea
21.3%
8.1%
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Further reading
References
  • 1. Boulenger JP, Huusom AK, Florea I, Baekdal T, Sarchiapone M. A comparative study of the efficacy of long-term treatment with escitalopram and paroxetine in severely depressed patients. Curr Med Res Opin. 2006 Jul;22(7):1331-41. PubMed
  • 2. Lin HL, Hsu YT, Liu CY, et al. Comparison of escitalopram and paroxetine in the treatment of major depressive disorder. Int Clin Psychopharmacol. 2013 Nov;28(6):339-45. PubMed
  • 12. Boulenger JP, Hermes A, Huusom AK, Weiller E. Baseline anxiety effect on outcome of SSRI treatment in patients with severe depression: escitalopram vs paroxetine. Curr Med Res Opin. 2010 Mar;26(3):605-14. PubMed
  • 13. Baldwin DS, Huusom AK, Maehlum E. Escitalopram and paroxetine in the treatment of generalised anxiety disorder: randomised, placebo-controlled, double-blind study. Br J Psychiatry. 2006 Sep;189:264-72. PubMed
  • 14. Bielski RJ, Bose A, Chang CC. A double-blind comparison of escitalopram and paroxetine in the long-term treatment of generalized anxiety disorder. Ann Clin Psychiatry. 2005 Apr-Jun;17(2):65-9. PubMed

Published: March 31, 2008
Last updated: February 20, 2017

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