The DOI matches its Crossref record; 9 of the 9 references it cites were found in a registry or an index.
A comparative review of escitalopram, paroxetine, and sertraline: are they all alike?
Open accessAbstract
It is known that newer antidepressants, such as the selective serotonin reuptake inhibitors (SSRIs), provide advantages in tolerability over antidepressants such as the tricyclics. However, even within the SSRI class, differences in efficacy or tolerability exist between the individual drugs. Among the three most widely prescribed SSRIs are paroxetine, sertraline, and escitalopram. Escitalopram is commonly referred to as an SSRI, but also has well-documented allosteric properties, and thus can be further classed as an allosteric serotonin reuptake inhibitor. All three antidepressants are efficacious compared with placebo, but there is evidence that escitalopram is more effective than a range of other antidepressants. There are no direct data to regard either paroxetine or sertraline as a superior antidepressant. Escitalopram is superior compared with paroxetine, which has a less favorable tolerability profile. Paroxetine is associated with cholinergic muscarinic antagonism and potent inhibition of CYP2D6, and sertraline has moderate drug interaction issues in comparison with escitalopram. Overall, as an allosteric serotonin reuptake inhibitor that is somewhat different from classical SSRIs, escitalopram is the first choice judged by combined efficacy and tolerability, and nonclinical data have offered possible mechanisms through which escitalopram could be more efficacious, based on its interaction with orthosteric and allosteric binding sites at the serotonin transporter.
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Paroxetine has strong anticholinergic properties.
“Among the SSRIs, paroxetine has strong anticholinergic properties and may lead to increased risk of adverse cognitive outcomes among elderly patients.”
From Risk of Dementia Among Elderly Nursing Home Patients Using Paroxetine and Other Selective Serotonin Reuptake Inhibitors (2015) · cites this paper as [20]
Paroxetine has higher affinity for muscarinic acetylcholine receptors compared with other SSRIs.
“Paroxetine was found to have higher affinity for muscarinic acetylcholine receptors compared with other SSRIs (20,21).”
From Risk of Dementia Among Elderly Nursing Home Patients Using Paroxetine and Other Selective Serotonin Reuptake Inhibitors (2015) · cites this paper as [20]
Paroxetine is a muscarinic antagonist and has a less favorable tolerability profile compared with escitalopram.
“Studies suggest that paroxetine is a muscarinic antagonist and has a less favorable tolerability profile compared with escitalopram (20).”
From Risk of Dementia Among Elderly Nursing Home Patients Using Paroxetine and Other Selective Serotonin Reuptake Inhibitors (2015) · cites this paper as [20]
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Citations
Cites
Cipriani, A., Furukawa, T. A., Salanti, G., Geddes, J. R., Higgins, J. P., Churchill, R., Watanabe, N., Nakagawa, A., Omori, I. M., McGuire, H., et al. (2009) · The Lancet · doi:10.1016/s0140-6736(09)60046-5 · Cited by 1,654
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“…SSRI treatment studied by PET using the radioligand [11C]N,N-dimethyl-2-(2-amino-4-cyanophenylthio) benzylamine ([11C]DASB) suggested that a SERT occupancy of B80% is necessary to achieve therapeutic effects of SSRI treatment and higher doses plateaued right above this range (Meyer et al., 2004).”
MethodLam, R. W., Kennedy, S. H., Grigoriadis, S., McIntyre, R. S., Milev, R., Ramasubbu, R., Parikh, S. V., Patten, S. B., & Ravindran, A. V. (2009) · Journal of Affective Disorders · doi:10.1016/j.jad.2009.06.041 · Cited by 431
Gartlehner, G., Hansen, R. A., Morgan, L. C., Thaler, K., Lux, L., Van Noord, M., Mager, U., Thieda, P., Gaynes, B. N., Wilkins, T., et al. (2011) · Annals of Internal Medicine · doi:10.7326/0003-4819-155-11-201112060-00009 · Cited by 355
Thase, M. E., Haight, B. R., Richard, N., Rockett, C. B., Mitton, M., Modell, J. G., VanMeter, S., Harriett, A. E., & Wang, Y. (2005) · The Journal of Clinical Psychiatry · doi:10.4088/jcp.v66n0803 · Cited by 304
Sánchez, C., & Meier, E. (1997) · Psychopharmacology · doi:10.1007/s002130050181 · Cited by 255
Self-citationDiscontinuation symptoms in depression and anxiety disorders
Baldwin, D. S., Montgomery, S. A., Nil, R., & Lader, M. (2007) · The International Journal of Neuropsychopharmacology · doi:10.1017/s1461145705006358 · Cited by 140
Self-citationMontgomery, S. A., & Möller, H.-J. (2009) · International Clinical Psychopharmacology · doi:10.1097/yic.0b013e32832a8eb2 · Cited by 121
Self-citationBaldwin, D. S., Cooper, J. A., Huusom, A. K. T., & Hindmarch, I. (2006) · International Clinical Psychopharmacology · doi:10.1097/01.yic.0000194377.88330.1d · Cited by 100 · cited 3×
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Metadata
- Authors
- Sanchez, C., Reines, E. H., & Montgomery, S. A.
- Affiliations
- Lundbeck (Denmark) (DK)
- University of London (GB)
- Venue
- International Clinical Psychopharmacology
- Published
- 2014-07
- Volume
- 29
- Issue
- 4
- Pages
- 185-196
- ISSN
- 0268-1315 (ISSN-L)
- PMC
- PMC4047306
- OpenAlex
- W1986777050
- Cited by
- 295
- References
- 9
- Citations by year
- 2026: 25 · 2025: 31 · 2024: 26 · 2023: 33 · 2022: 35 · 2021: 29 · 2020: 25 · 2019: 23 · 2018: 24 · 2017: 13 · 2016: 19 · 2015: 9 · 2014: 3
- FWCI
- 9.71
- Type
- journal article
- Language
- en
- Open access
- green
- www.ncbi.nlm.nih.gov
- Licence
- cc-by-nc-nd
- Locations
- International Clinical Psychopharmacology (publishedVersion)
- Europe PMC (PubMed Central) (publishedVersion, cc-by-nc-nd)
- PubMed Central (publishedVersion, cc-by-nc-nd)
- PubMed (publishedVersion)
- Topics
- Health Sciences › Medicine › Pharmacology (medical) › Treatment of Major Depression
- Life Sciences › Neuroscience › Cellular and Molecular Neuroscience › Neurotransmitter Receptor Influence on Behavior
- Social Sciences › Psychology › Experimental and Cognitive Psychology › Anxiety, Depression, Psychometrics, Treatment, Cognitive Processes
- Keywords
- escitalopram, paroxetine, sertraline, selective serotonin reuptake inhibitors, antidepressant efficacy, drug tolerability, serotonin transporter, muscarinic antagonism, CYP2D6 inhibition, drug interactions, tricyclic antidepressants
- MeSH terms
- Allosteric Site, Animals, Depression, Major Depressive Disorder, Drug Interactions, Humans, Models, Biological, Nerve Tissue Proteins, Citalopram, Selective Serotonin Reuptake Inhibitors, Paroxetine, Antidepressive Agents, Second-Generation, Evidence-Based Medicine, Sertraline, Serotonin Plasma Membrane Transport Proteins
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