[Escitalopram--second generation of serotonin transporter inhibitors?].
Escitalopram is the first antidepressant introduced according to chirality rules, it is an S-enantiomer of citalopram, the drug which has been used for many years. Experimental studies showed that the property of serotonin transporter inhibition--one of the main mechanisms of antidepressive action is connected with the S-enantiomer of citalopram, and that escitalopram is the most selective inhibitor of this transporter. The results of most clinical studies in patients with depression show significant superiority of escitalopram, 10-20 mg/day, over placebo, as early as within the first week of treatment, and a faster onset of action and higher therapeutic efficacy of escitalopram, compared to citalopram, 20-40 mg/day. A similar efficacy of escitalopram, 10 mg/day, and sertraline 50-200 mg/day, as well as escitalopram, 20 mg/day, and venlafaxine, 225 mg/day was demonstrated. It has also been shown that escitalopram, 10-20 mg/day, exerts therapeutic efficacy in general anxiety disorder, panic disorder and social phobia. Escitalopram may meet many criteria for the optimal antidepressant. The drug is efficacious in depressions of various intensity, has a rapid onset of action and, in long-term treatment, prevents the relapses of the illness. It exerts therapeutic activity in anxiety disorders. The dosing is convenient, and the drug is safe and well tolerated due to a mild profile of side-effects and favorable pharmacokinetic properties. Further studies are needed, aiming e.g. at the comparison of the therapeutic efficacy of escitalopram with other antidepressant drugs in different patients and the assessment of the effect of the drug on cognitive functions. The results of such studies may provide a convincing answer to the question whether escitalopram can be regarded as an antidepressant drug belonging to the second generation of serotonin transporter inhibitors.
Z Kliniki Psychiatrii Dorosłych AM w Poznaniu.
Janusz
J
Rybakowski
Alina B
AB
Borkowska
D000818:Animals; D018687:Antidepressive Agents, Second-Generation / Q000494:pharmacology / Q000627:therapeutic use; D001008:Anxiety Disorders / Q000188:drug therapy*; D015283:Citalopram / Q000494:pharmacology / Q000627:therapeutic use; D003866:Depressive Disorder / Q000188:drug therapy*; D004305:Dose-Response Relationship, Drug; D004334:Drug Administration Schedule; D006801:Humans; D016584:Panic Disorder / Q000188:drug therapy; D017367:Selective Serotonin Reuptake Inhibitors / Q000494:pharmacology / Q000627:therapeutic use
D018687:Antidepressive Agents, Second-Generation; D015283:Citalopram; D017367:Selective Serotonin Reuptake Inhibitors