The onset of effect for escitalopram and its relevance for the clinical management of depression.
OBJECTIVE
To analyse the significance of 'onset of effect' on clinical outcome in the treatment of depression and the contribution of individual Montgomery-Asberg Depression Rating Scale (MADRS) items to improvements in the MADRS total score.


METHODS
All five published placebo-controlled clinical studies in depression as per January 1, 2005, with escitalopram, were included in this pooled analysis.


RESULTS
Of the 1636 patients who were randomised to either escitalopram (882) or placebo (754), 1333 completed 8 weeks of treatment (707 escitalopram and 626 placebo). A statistically significant difference (p < 0.05) between the MADRS total score responses of escitalopram and placebo treatments was observed at week 1. All 10 MADRS single items showed a significant treatment effect at week 8. For items representing core symptoms of depression (apparent sadness, reported sadness, inner tension, concentration difficulties, inability to feel, pessimistic thoughts and suicidal thoughts) the effect was detected early (week 1) and for other items (reduced sleep, reduced appetite and lassitude) the effect was detected later (week 6-8). Of the patients who showed an onset of effect (> or = 20% reduction in MADRS) after 2 weeks, and who remained on escitalopram until week 8, 63% were in remission at week 8 (mean MADRS score of 6.1).


CONCLUSIONS
Onset of treatment response at 2 weeks is an important indicator of subsequent remission at 8 weeks. It would therefore be a reasonable clinical recommendation that if patients fail to show a measurable clinical improvement within 2 weeks, a dose increase should be considered at this time.
Wade
Alan
A
CPS Clinical Research Centre, Glasgow, UK. alan@edgehill.demon.co.uk
Friis Andersen
Henning
H
D000328:Adult; D000368:Aged; D018687:Antidepressive Agents, Second-Generation / Q000627:therapeutic use*; D015283:Citalopram / Q000627:therapeutic use*; D003863:Depression / Q000188:drug therapy* / Q000503:physiopathology / Q000523:psychology; D005260:Female; D006801:Humans; D008297:Male; D008875:Middle Aged; D015337:Multicenter Studies as Topic; D011569:Psychiatric Status Rating Scales; D016032:Randomized Controlled Trials as Topic; D013997:Time Factors; D016896:Treatment Outcome
D018687:Antidepressive Agents, Second-Generation; D015283:Citalopram