A double-blind comparison of escitalopram and paroxetine in the long-term treatment of generalized anxiety disorder.
BACKGROUND
This study compared the efficacy and tolerability of escitalopram, a newer SSRI, with paroxetine in the treatment of generalized anxiety disorder (GAD).


METHODS
Patients with DSM-IV-defined GAD were randomized to receive 24 weeks of double-blind flexible-dose treatment with either escitalopram (10-20 mg/day) or paroxetine (20-50 mg/day), followed by a 2-week, double-blind, down-titration period. Mean change from baseline to endpoint (LOCF) in Hamilton Anxiety Scale (HAMA) scores was the primary efficacy variable.


RESULTS
Mean baseline HAMA scores for the escitalopram (N = 60) and paroxetine (N = 61) groups were 23.7 and 23.4, respectively. After 24 weeks of treatment, mean changes in HAMA scores were -15.3 and -13.3 for escitalopram and paroxetine, respectively (p = 0.13). Significantly fewer patients withdrew from escitalopram than paroxetine treatment due to adverse events (6.6% vs. 22.6%; p = 0.02). The frequency of treatment-emergent adverse events was 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 were reported more with escitalopram than paroxetine (21.3% vs. 8.1%, and 14.8% vs. 4.8%, respectively).


CONCLUSIONS
These results support the use of escitalopram as a first-line treatment for GAD.
Bielski
Robert J
RJ
Summit Research Network, 4084 Okemos Road. Suite C, Okemos, MI 48864, USA. rbielski@summitnetwork.com
Bose
Anjana
A
Chang
Chung-Chi
CC
D000328:Adult; D001008:Anxiety Disorders / Q000188:drug therapy* / Q000523:psychology; D015283:Citalopram / Q000008:administration & dosage / Q000009:adverse effects / Q000627:therapeutic use*; D004311:Double-Blind Method; D005260:Female; D006801:Humans; D008297:Male; D008875:Middle Aged; D017374:Paroxetine / Q000008:administration & dosage / Q000009:adverse effects / Q000627:therapeutic use*; D010919:Placebos; D017367:Selective Serotonin Reuptake Inhibitors / Q000008:administration & dosage / Q000009:adverse effects / Q000627:therapeutic use*; D016896:Treatment Outcome
D015283:Citalopram; D017374:Paroxetine; D010919:Placebos; D017367:Selective Serotonin Reuptake Inhibitors