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Escitalopram (Lexapro) versus Other Antidepressants

Escitalopram (Lexapro) vs. Citalopram (Celexa)
  • Efficacy:
    • 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 relief 8.
      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)
  • Efficacy:
    • 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 3.
  • 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%, respectively) 2.
  • Withdrawal symptoms: Paroxetine treatment is associated with significantly more discontinuation symptoms than escitalopram 4.

Escitalopram (Lexapro) vs. Sertraline (Zoloft)
  • Efficacy:
    Depression: Sertraline and escitalopram have comparable antidepressant efficacy in the treatment of major depressive disorder 7.
  • Side effects: Both are generally well tolerated 7.
Escitalopram (Lexapro) vs. Venlafaxine (Effexor)
  • Efficacy:
    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, 6.

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.

  • Efficacy:
    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 14.
    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 13.

Further reading
References
  • 1. Bielski RJ, Ventura D, Chang CC. A double-blind comparison of escitalopram and venlafaxine extended release in the treatment of major depressive disorder. J Clin Psychiatry. 2004 Sep;65(9):1190-6. PubMed
  • 2. 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
  • 3. 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
  • 4. Baldwin DS, Cooper JA, Huusom AK, Hindmarch I. A double-blind, randomized, parallel-group study to evaluate the tolerability, efficacy and effects of treatment discontinuation with escitalopram and paroxetine in patients with major depressive disorder. Int Clin Psychopharmacol. 2006 May;21(3):159-69. PubMed
  • 5. 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
  • 6. Montgomery SA, Huusom AK, Bothmer J. A randomised study comparing escitalopram with venlafaxine XR in primary care patients with major depressive disorder. Neuropsychobiology. 2004;50(1):57-64. PubMed
  • 7. Ventura D, Armstrong EP, Skrepnek GH, Haim Erder M. Escitalopram versus sertraline in the treatment of major depressive disorder: a randomized clinical trial. Curr Med Res Opin. 2007 Feb;23(2):245-50. PubMed
  • 8. Sanchez C, B?ges? KP, Ebert B, Reines EH, Braestrup C. Escitalopram versus citalopram: the surprising role of the R-enantiomer. Psychopharmacology (Berl). 2004 Jul;174(2):163-76. PubMed
  • 9. Wade AG, Toumi I, Hemels ME. A pharmacoeconomic evaluation of escitalopram versus citalopram in the treatment of severe depression in the United Kingdom. Clin Ther. 2005 Apr;27(4):486-96. PubMed
  • 10. 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
  • 11. 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.
  • 12. Schreiber S, Pick CG. From selective to highly selective SSRIs: a comparison of the antinociceptive properties of fluoxetine, fluvoxamine, citalopram and escitalopram. Eur Neuropsychopharmacol. 2006 Aug;16(6):464-8. Epub 2006 Jan 18. PubMed
  • 13. 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
  • 14. 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

Published: March 31, 2008
Last updated: April 10, 2012

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