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Escitalopram (Lexapro) versus ...

Escitalopram (Lexapro) vs. Citalopram (Celexa)

Difference between Escitalopram and Citalopram chart

 
Escitalopram
Lexapro®
Citalopram
Celexa®
Drug class
Antidepressant,
Serotonin-Norepinephrine Reuptake inhibitor
Stereochemistry S-enantiomer of racemic citalopram. S-enantiomer is considered the active component of the racemate. Racemic mixture of R- and S-enantiomers.
Common FDA approved indications
Major Depressive Disorder
Other FDA-approved indications Generalized Anxiety Disorder  
Starting dose 10 mg 20 mg
Maximum dose 20 mg 40 mg
Side effects The incidence of adverse events and withdrawals do not differ significantly between escitalopram and citalopram 2.
Safety in overdose Escitalopram is less toxic than citalopram after an acute overdose 4. Escitalopram causes fewer seizures and tremors in overdose than citalopram 3.
Contraindications/warnings Concomitant use with MAOIs
Concomitant use with Pimozide
Hypersensitivity to escitalopram or citalopram

Efficacy
Several clinical studies have found significant superior efficacy of escitalopram compared to citalopram, including higher rates of response and remission6, 9. Escitalopram is more effective than citalopram in the treatment of severe depression 8.

The lower efficacy of citalopram in the studies is apparently due to the inhibition of the effect of the S-enantiomer by the R-enantiomer7.

However, there is evidence that in the short-to-medium term treatment of major depressive disorder escitalopram and citalopram are equally effective10.

Geriatric patients
Escitalopram may offer better treatment persistence, fewer hospitalizations, and lower medical and total healthcare costs in the treatment of major depressive disorder in geriatric patients 5.

Antinociceptive properties
Research shows that citalopram injected intraperitoneally is a weak antinociceptor, while escitalopram possesses no antinociceptive properties 11.

Results of prospective, randomized, double-blind, active-controlled study of escitalopram versus citalopram in major depressive disorder 6.
Escitalopram
Citalopram
Regimen 10 mg daily for 6 weeks 20 mg daily for 6 weeks
Mean change from baseline in MADRS total score at the end of study
-28.70
-25.19
Mean change from baseline in MADRS total score in the severely depressed subgroup
-30.33
-26.34
Changes in the Clinical Global Impression-Severity and Improvement scores
-2.60
+1.58
-2.05
+1.80
Response rate
95.4%
83.3%
Remission rate
89.8%
50.9%
Adverse events, most frequently reported:    
nausea
1.9%
6.5%
headache
0.9%
3.7%


Results of randomized, double-blind study of escitalopram versus citalopram in major depressive disorder 9.
Escitalopram
Citalopram
Regimen 20 mg daily over 8 weeks 40 mg daily over 8 weeks
Premature withdrawal, number of patients
6 of 138 patients
15 of 142 patients
Change in the MADRS total score from baseline to last assessment
-22.4+/-12.9
-20.3+/-12.7
Response rate
76.1%
61.3%
Remission rate
56.1%
43.6%
Tolerability
similar

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.

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%

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. Ou JJ, Xun GL, Wu RR, et al. Efficacy and safety of escitalopram versus citalopram in major depressive disorder: a 6-week, multicenter, randomized, double-blind, flexible-dose study. Psychopharmacology (Berl). 2011 Feb;213(2-3):639-46. PubMed
  • 3. Yilmaz Z, Ceschi A, Rauber-Lüthy C, et al. Escitalopram causes fewer seizures in human overdose than citalopram. Clin Toxicol (Phila). 2010 Mar;48(3):207-12. PubMed
  • 4. Hayes BD, Klein-Schwartz W, Clark RF, Muller AA, Miloradovich JE. Comparison of toxicity of acute overdoses with citalopram and escitalopram. J Emerg Med. 2010 Jul;39(1):44-8. PubMed
  • 5. Wu E, Greenberg PE, Yang E, Yu A, Erder MH. Comparison of escitalopram versus citalopram for the treatment of major depressive disorder in a geriatric population. Curr Med Res Opin. 2008 Sep;24(9):2587-95 PubMed
  • 6. Yevtushenko VY, Belous AI, Yevtushenko YG, Gusinin SE, Buzik OJ, Agibalova TV. 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 Nov;29(11):2319-32. PubMed
  • 7. Jacquot C, David DJ, Gardier AM, Sánchez C. Escitalopram and citalopram: the unexpected role of the R-enantiomer. Encephale. 2007 Mar-Apr;33(2):179-87. PubMed
  • 8. Azorin JM, Llorca PM, Despiegel N, Verpillat P. Escitalopram is more effective than citalopram for the treatment of severe major depressive disorder. Encephale. 2004 Mar-Apr;30(2):158-66. PubMed
  • 9. Moore N, Verdoux H, Fantino B. Prospective, multicentre, randomized, double-blind study of the efficacy of escitalopram versus citalopram in outpatient treatment of major depressive disorder. Int Clin Psychopharmacol. 2005 May;20(3):131-7. PubMed
  • 10. Trkulja V. Is escitalopram really relevantly superior to citalopram in treatment of major depressive disorder? A meta-analysis of head-to-head randomized trials. Croat Med J. 2010 Feb;51(1):61-73. PubMed
  • 11. Schreiber S, Pick CG. From selective to highly selective SSRIs: a comparison of the antinociceptive properties. Eur Neuropsychopharmacol. 2006 Aug;16(6):464-8. Epub 2006 Jan 18. 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: July 07, 2014

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