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Cited by 190Treatment of Major DepressionAnxiety, Depression, Psychometrics, Treatment, Cognitive ProcessesMental Health Treatment and Access

Escitalopram versus other antidepressive agents for depression

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Cipriani, Andrea, Santilli, Claudio, Furukawa, Toshi A, Signoretti, Alessandra, Nakagawa, Atsuo, McGuire, Hugh, Churchill, Rachel, Barbui, Corrado·2009·Cochrane Database of Systematic Reviews
DOI 10.1002/14651858.cd006532.pub2PMC PMC4164382
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Abstract

BACKGROUND: Although pharmacological and psychological interventions are both effective for major depression, antidepressant drugs remain the mainstay of treatment in primary and secondary care settings. During the last 20 years, antidepressant prescribing has risen dramatically in western countries, mainly because of the increasing consumption of selective serotonin reuptake inhibitors (SSRIs) and newer antidepressants, which have progressively become the most commonly prescribed antidepressants. Escitalopram is the pure S-enantiomer of the racemic citalopram. OBJECTIVES: To assess the evidence for the efficacy, acceptability and tolerability of escitalopram in comparison with tricyclics, other SSRIs, heterocyclics and newer agents in the acute-phase treatment of major depression. SEARCH STRATEGY: Electronic databases were searched up to July 2008. Trial databases of drug-approving agencies were hand-searched for published, unpublished and ongoing controlled trials. SELECTION CRITERIA: All randomised controlled trials comparing escitalopram against any other antidepressant (including non-conventional agents such as hypericum) for patients with major depressive disorder (regardless of the diagnostic criteria used). DATA COLLECTION AND ANALYSIS: Data were entered by two review authors (double data entry). Responders and remitters to treatment were calculated on an intention-to-treat basis. For dichotomous data, odds ratios (ORs) were calculated with 95% confidence intervals (CI). Continuous data were analysed using standardised mean differences (with 95% CI) using the random effects model. MAIN RESULTS: Fourteen trials compared escitalopram with another SSRI and eight compared escitalopram with a newer antidepressive agent (venlafaxine, bupropion and duloxetine). Escitalopram was shown to be significantly more effective than citalopram in achieving acute response (OR 0.67, 95% CI 0.50 to 0.87). Escitalopram was also more effective than citalopram in terms of remission (OR 0.53, 95% CI 0.30 to 0.93). Significantly fewer patients allocated to escitalopram withdrew from trials compared with patients allocated to duloxetine, for discontinuation due to any cause (OR 0.62, 95% CI 0.38 to 0.99). AUTHORS' CONCLUSIONS: Some statistically significant differences favouring escitalopram over other antidepressive agents for the acute phase treatment of major depression were found, in terms of efficacy (citalopram and fluoxetine) and acceptability (duloxetine). There is insufficient evidence to detect a difference between escitalopram and other antidepressants in early response to treatment (after two weeks of treatment). Cost-effectiveness information is also needed in the field of antidepressant trials. Furthermore, as with most standard systematic reviews, the findings rely on evidence from direct comparisons. The potential for overestimation of treatment effect due to sponsorship bias should also be borne in mind.

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Research works printed but not linked: 4

  1. American Psychiatric Association Diagnostical and Statistical Manual of Mental Disorders (DSM-III) 1980 APA Washington, DC 3rd Edition
  2. American Psychiatric Association Diagnostical and Statistical Manual of Mental Disorders (DSM-IV) 1994 American Psychiatric Association Washington, DC 4rd Edition
  3. Hansen RA Gartlehner G Lohr KN Gaynes BN Carey TS Efficacy and safety of second-generation of antidepressants in the treatment of major depressive disorder Annals of Internal Medicine 2005 143 415 26 16172440
  4. Higgins JP Green S Cochrane Handbook for Systematic Reviews of Interventions 2005 John Wiley & Sons, Ltd Chichester

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Authors
Cipriani, A., Santilli, C., Furukawa, T. A., Signoretti, A., Nakagawa, A., McGuire, H., Churchill, R., & Barbui, C.
Affiliations
  • Warneford Hospital (GB)
  • University of Perugia (IT)
  • Kyoto University (JP)
  • University of Verona (IT)
  • Keio University (JP)
  • National Collaborating Centre for Women's and Children's Health; 4th Floor, King's Court 2-16 Goodge Street London UK W1T 2QA
  • University of Bristol (GB)
ORCID
Venue
Cochrane Database of Systematic Reviews
Publisher
Wiley
Published
2009-04-15
Volume
2016
Issue
5
Pages
CD006532-CD006532
ISSN
  • 1361-6137 (ISSN-L)
  • 1465-1858
DOI
10.1002/14651858.cd006532.pub2
PMC
PMC4164382
OpenAlex
W2169083980
Cited by
190
References
101
Citations by year
2026: 1 · 2025: 5 · 2024: 7 · 2023: 4 · 2022: 7 · 2021: 9 · 2020: 6 · 2019: 11 · 2018: 8 · 2017: 7 · 2016: 8 · 2015: 12 · 2014: 15 · 2013: 17 · 2012: 14
FWCI
2.47
Type
journal article
Language
en
Open access
Locations
  • Cochrane Database of Systematic Reviews (publishedVersion)
  • PubMed (publishedVersion)
  • Europe PMC (PubMed Central) (acceptedVersion)
  • PubMed Central (acceptedVersion)
  • Explore Bristol Research (submittedVersion)
  • Bristol Research (University of Bristol) (submittedVersion)
Topics
  • Health Sciences › Medicine › Pharmacology › Treatment of Major Depression
  • Social Sciences › Psychology › Experimental and Cognitive Psychology › Anxiety, Depression, Psychometrics, Treatment, Cognitive Processes
  • Social Sciences › Psychology › Social Psychology › Mental Health Treatment and Access
Keywords
escitalopram, major depressive disorder, antidepressant efficacy, selective serotonin reuptake inhibitors, citalopram, venlafaxine, bupropion, duloxetine, tricyclic antidepressants, heterocyclic antidepressants, acute phase treatment, remission, treatment discontinuation, tolerability, antidepressant prescribing, Hypericum, cost-effectiveness
MeSH terms
Antidepressive Agents, Depression, Humans, Citalopram, Randomized Controlled Trials as Topic, Selective Serotonin Reuptake Inhibitors

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