title: Escitalopram: a review of its use in the management of major depressive disorder in adults.
abstract: Escitalopram (escitalopram oxalate; Cipralex, Lexapro), a selective serotonin reuptake inhibitor (SSRI) indicated for the treatment of major depressive disorder (MDD), demonstrates a highly selective and potent, dose-dependent inhibition of the human serotonin transporter, inhibiting serotonin reuptake into presynaptic nerve terminals and thus increasing serotonergic activity in the CNS. With regard to primary endpoints (such as improved scores on the Montgomery-Asberg Depression Rating Scale [MADRS] and the Hamilton Depression Rating Scale [HAM-D]), escitalopram was generally more effective than placebo, at least as effective as citalopram, and generally at least as effective as other comparator drugs, including the SSRIs fluoxetine, paroxetine and sertraline, the serotonin-noradrenaline (norepinephrine) reuptake inhibitors (SNRIs) venlafaxine extended release and duloxetine, and the aminoketone bupropion in adult patients with MDD in short-term, well designed trials. Moreover, it demonstrated a rapid onset of antidepressant action. Escitalopram was also found to be cost effective in several studies, dominating other SSRIs and venlafaxine extended release. Maintenance therapy is commonly required to prevent recurrence of depression. Long-term trials corroborated short-term results, with escitalopram demonstrating greater efficacy than placebo in relapse prevention. Additionally, escitalopram was at least as effective as citalopram, paroxetine and duloxetine in long-term comparative trials. Escitalopram has a predictable tolerability profile with generally mild to moderate and transient adverse events, and a low propensity for drug interactions. Sexual dysfunction with escitalopram treatment appeared to occur to a similar or lower extent to that with paroxetine (another SSRI), to a similar or greater extent to that with the SNRI duloxetine, and to a greater extent than that with the aminoketone bupropion. Thus, escitalopram is an effective and generally well tolerated treatment for moderate to severe MDD. Escitalopram, like other SSRIs, is an effective first-line option in the management of patients with MDD.
authors.affiliation: Adis, a Wolters Kluwer Business, Auckland, New Zealand. demail@adis.co.nz
authors.forename: Karly P
authors.initials: KP
authors.lastname: Garnock-Jones
authors.forename: Paul L
authors.initials: PL
authors.lastname: McCormack
mesh_terms: D000328:Adult; D015283:Citalopram / Q000009:adverse effects / Q000627:therapeutic use*; D003865:Major Depressive Disorder / Q000188:drug therapy*; D006801:Humans; D017367:Selective Serotonin Reuptake Inhibitors / Q000009:adverse effects / Q000627:therapeutic use*
chemical_list: D015283:Citalopram; D017367:Selective Serotonin Reuptake Inhibitors
references.citation: Epidemiol Rev. 2008;30:101-17
references.pmid: 18753674
references.citation: Pharmacogenet Genomics. 2009 Sep;19(9):666-74
references.pmid: 19724244
references.citation: CNS Drugs. 2003;17(5):343-62
references.pmid: 12665392
references.citation: Curr Med Res Opin. 2006 Jul;22(7):1331-41
references.pmid: 16834832
references.citation: Depress Anxiety. 2008;25(1):46-54
references.pmid: 17149753
references.citation: Prev Chronic Dis. 2008 Jan;5(1):A22
references.pmid: 18082011
references.citation: Psychopharmacology (Berl). 2011 Feb;213(2-3):639-46
references.pmid: 20340011
references.citation: Int Clin Psychopharmacol. 2008 Sep;23(5):276-86
references.pmid: 18703937
references.citation: J Clin Psychiatry. 2004 Jan;65(1):44-9
references.pmid: 14744167
references.citation: J Emerg Med. 2010 Jul;39(1):44-8
references.pmid: 19081700
references.citation: Pharmacoeconomics. 2003;21(16):1185-209
references.pmid: 14594439
references.citation: J Sex Med. 2007 Jul;4(4 Pt 1):917-29
references.pmid: 17627739
references.citation: Curr Med Res Opin. 2007 Feb;23(2):245-50
references.pmid: 17288677
references.citation: Curr Med Res Opin. 2007 Feb;23(2):401-16
references.pmid: 17288694
references.citation: Pharmacopsychiatry. 2007 Mar;40(2):53-7
references.pmid: 17447173
references.citation: Int Clin Psychopharmacol. 2009 May;24(3):119-25
references.pmid: 19367152
references.citation: J Clin Psychiatry. 2008 Mar;69(3):392-9
references.pmid: 18348597
references.citation: Psychopharmacol Bull. 2008;41(2):58-85
references.pmid: 18668017
references.citation: Curr Med Res Opin. 2007 Jul;23(7):1605-14
references.pmid: 17559755
references.citation: BMJ. 2005 Feb 19;330(7488):385
references.pmid: 15718537
references.citation: Am J Geriatr Pharmacother. 2006 Sep;4(3):201-9
references.pmid: 17062320
references.citation: Int Clin Psychopharmacol. 2002 May;17(3):95-102
references.pmid: 11981349
references.citation: J Neurochem. 2005 Jan;92(1):21-8
references.pmid: 15606893
references.citation: Curr Med Res Opin. 2007 Jun;23(6):1303-18
references.pmid: 17559729
references.citation: J Psychiatr Res. 2009 Jan;43(3):247-54
references.pmid: 18511076
references.citation: Ann Clin Psychiatry. 2006 Apr-Jun;18(2):83-9
references.pmid: 16754413
references.citation: Prim Care Companion J Clin Psychiatry. 2003 Aug;5(4):153-157
references.pmid: 15213776
references.citation: J Clin Psychiatry. 2002 Apr;63(4):331-6
references.pmid: 12000207
references.citation: Eur Neuropsychopharmacol. 2009 Apr;19(4):229-37
references.pmid: 19185467
references.citation: J Clin Psychopharmacol. 2006 Apr;26(2):172-7
references.pmid: 16633147
references.citation: Biol Psychiatry. 2001 Sep 1;50(5):345-50
references.pmid: 11543737
references.citation: Int Clin Psychopharmacol. 2006 May;21(3):159-69
references.pmid: 16528138
references.citation: Int J Psychiatry Clin Pract. 2009;13(1):59-69
references.pmid: 24946123
references.citation: Clin Drug Investig. 2007;27(7):481-92
references.pmid: 17563128
references.citation: Eur Neuropsychopharmacol. 2005 Mar;15(2):193-8
references.pmid: 15695064
references.citation: Int J Clin Pract. 2007 Apr;61(4):702-10
references.pmid: 17394446
references.citation: J Clin Pharmacol. 2005 Dec;45(12):1400-6
references.pmid: 16291715
references.citation: Am J Geriatr Psychiatry. 2007 Jul;15(7):581-93
references.pmid: 17586783
references.citation: J Clin Psychiatry. 2004 Sep;65(9):1190-6
references.pmid: 15367045
references.citation: Ann Pharmacother. 2007 Oct;41(10):1583-92
references.pmid: 17848424
references.citation: Br J Clin Pharmacol. 2003 Oct;56(4):415-21
references.pmid: 12968986
references.citation: Int J Clin Pract. 2005 Mar;59(3):268-75
references.pmid: 15857321
references.citation: CNS Drugs. 2006;20(9):763-90
references.pmid: 16953656
references.citation: J Biol Chem. 2006 Jan 27;281(4):2012-23
references.pmid: 16272152
references.citation: Neuropsychobiology. 2004;50(1):57-64
references.pmid: 15179022
references.citation: Psychopharmacology (Berl). 2007 Apr;191(2):333-9
references.pmid: 17235610
references.citation: J Med Assoc Thai. 2008 Jul;91(7):1117-28
references.pmid: 18839855
references.citation: Eur J Health Econ. 2005 Dec;6(4):317-21
references.pmid: 16267659
references.citation: Psychiatry Clin Neurosci. 2007 Oct;61(5):522-8
references.pmid: 17875031
references.citation: Neuropsychopharmacology. 2009 Jun;34(7):1819-28
references.pmid: 19295509
references.citation: Tidsskr Nor Laegeforen. 2005 Sep 22;125(18):2470-3
references.pmid: 16186862
references.citation: Paediatr Drugs. 2010 Jun;12(3):155-63
references.pmid: 20481645
references.citation: Am J Geriatr Psychiatry. 2005 Oct;13(10):884-91
references.pmid: 16223967
references.citation: Psychopharmacology (Berl). 2006 Oct;188(3):263-72
references.pmid: 16955282
references.citation: Int J Neuropsychopharmacol. 2010 Feb;13(1):103-8
references.pmid: 19835669
references.citation: Neuropsychobiology. 2006;54(3):152-9
references.pmid: 17230032
references.citation: Pharmacopsychiatry. 2008 Mar;41(2):41-7
references.pmid: 18311683
references.citation: Lancet. 2006 Jun 17;367(9527):1959-62
references.pmid: 16782468
references.citation: Int Clin Psychopharmacol. 2003 Jul;18(4):211-7
references.pmid: 12817155
references.citation: Clin Pharmacokinet. 2007;46(4):281-90
references.pmid: 17375980
references.citation: Drugs. 2005;65(16):2379-404
references.pmid: 16266205
references.citation: Curr Med Res Opin. 2005 Oct;21(10):1659-68
references.pmid: 16238906
references.citation: Curr Med Res Opin. 2007 Feb;23(2):251-8
references.pmid: 17288678
references.citation: Int J Neuropsychopharmacol. 2008 May;11(3):381-8
references.pmid: 17697395
references.citation: Depress Anxiety. 2005;21(1):26-32
references.pmid: 15786487
references.citation: Clin Toxicol (Phila). 2010 Mar;48(3):207-12
references.pmid: 20170390
references.citation: J Clin Psychiatry. 2006 Nov;67(11):1767-75
references.pmid: 17196058
references.citation: Pharmacopsychiatry. 2006 Sep;39(5):180-4
references.pmid: 16944409
references.citation: Aust N Z J Psychiatry. 2004 Jun;38(6):389-407
references.pmid: 15209830
references.citation: Eur J Clin Pharmacol. 1998 May;54(3):237-42
references.pmid: 9681666
references.citation: J Clin Psychiatry. 2001;62 Suppl 8:4-9; discussion 10-1
references.pmid: 12108821
references.citation: Prim Care Companion J Clin Psychiatry. 2001 Dec;3(6):232-235
references.pmid: 15014590
references.citation: J Clin Psychopharmacol. 2009 Aug;29(4):368-71
references.pmid: 19593177
references.citation: Am J Geriatr Psychiatry. 2008 Jan;16(1):14-20
references.pmid: 18165459
references.citation: Expert Opin Pharmacother. 2009 Apr;10(6):927-36
references.pmid: 19317630
references.citation: Pharmacoeconomics. 2008;26(11):969-81
references.pmid: 18850765
references.citation: J Clin Psychiatry. 2005 Dec;66(12):1569-75
references.pmid: 16401159
references.citation: J Clin Psychiatry. 2001;62 Suppl 22:5-9
references.pmid: 11599650
references.citation: J Sex Marital Ther. 2005 May-Jun;31(3):257-62
references.pmid: 16020143
references.citation: Int Clin Psychopharmacol. 2005 May;20(3):139-43
references.pmid: 15812263
references.citation: Neuropsychobiology. 2006;54(4):201-7
references.pmid: 17337913
references.citation: Clin Ther. 2007 Nov;29(11):2319-32
references.pmid: 18158074
references.citation: J Psychiatr Pract. 2008 Sep;14(5):271-80
references.pmid: 18832958
references.citation: Croat Med J. 2010 Feb;51(1):61-73
references.pmid: 20162747
references.citation: J Clin Psychiatry. 2006 May;67(5):736-46
references.pmid: 16841623
references.citation: J Clin Psychopharmacol. 2004 Apr;24(2):209-13
references.pmid: 15206668
references.citation: Indian J Psychiatry. 2004 Oct;46(4):333-41
references.pmid: 21206792
references.citation: Int Clin Psychopharmacol. 2005 May;20(3):131-7
references.pmid: 15812262
references.citation: Nord J Psychiatry. 2007;61(2):100-8
references.pmid: 17454724
references.citation: Lancet. 2009 Feb 28;373(9665):746-58
references.pmid: 19185342
references.citation: AAPS J. 2006 Jan 20;8(1):E14-9
references.pmid: 16584121
references.citation: Cochrane Database Syst Rev. 2009 Apr 15;(2):CD006532
references.pmid: 19370639
references.citation: Int Clin Psychopharmacol. 2007 Mar;22(2):107-15
references.pmid: 17293711
references.citation: Am J Psychiatry. 2007 Oct;164(10):1530-8
references.pmid: 17898344
references.citation: Expert Opin Pharmacother. 2009 Apr;10(6):937-45
references.pmid: 19364246
references.citation: Int J Clin Pract. 2005 Dec;59(12):1428-34
references.pmid: 16351675