Abstract

Objective. Escitalopram is the most selective of the selective serotonin reuptake inhibitor (SSRI) antidepressants. Previous studies have suggested that escitalopram is superior to citalopram in efficacy. We conducted a meta-analysis of studies in which escitalopram was compared with other antidepressants to assess the relative efficacy of these agents.
Methods. Data from all randomized, double-blind studies of major depression in which escitalopram was compared with active controls (citalopram, fluoxetine, paroxetine, sertraline and venlafaxine XR (extended release)) were pooled. Ten studies were conducted both in specialist settings and in general practice. The patients met the criteria of the Diagnostic and Statistical Manual of Mental Disorders, fourth edition (DSM-IV), for major depressive disorder and were at least 18 years old. In all but 2 studies, patients were required to have a score of 22 or more on the Montgomery-Åsberg Depression Rating Scale (MADRS). The primary outcome measure was the estimated difference in the effect of treatment on the MADRS total score at the end of the study. Secondary outcome measures were response to treatment (defined as a 50% reduction in the baseline MADRS total score)  and remission rate (defined as MADRS total score ≤12 at end of study).
Results. A total of 2687 patients were included in the analyses (escitalopram n = 1345, conventional SSRIs n = 1102, venlafaxine XR n = 240). Escitalopram was superior to all comparators in overall treatment effect, with an estimated difference of 1.07 points in the effect of treatment (95% confidence interval [CI] 0.42–1.73, p <0.01), and in response (odds ratio [OR] 1.29, 95% CI 1.07–1.56, p <0.01) and remission (OR 1.21, 95% CI 1.01–1.46, p <0.05) rates. In analysis by medication classes, escitalopram was significantly superior to the SSRIs and comparable to venlafaxine, although the overall results do not necessarily reflect a significant difference between escitalopram and individual SSRIs. These results were similar in the severely depressed population (patients with baseline MADRS 30). The withdrawal rate due to adverse events was 6.7% for escitalopram compared with 9.1% for the comparators (p <0.05).
Conclusions. In this meta-analysis, escitalopram showed a significant superiority in efficacy compared with active controls.