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CINP: Escitalopram Superior to Citalopram for Severe Depression By Danny Kucharsky Special to DG News MONTREAL, QC -- June 27, 2002 -- Escitalopram should be considered as a first-line antidepressant, even in severely depressed patients. That is the conclusion of three pooled double-blind, placebo-controlled trials of similar design that examined escitalopram (10 to 20 mg/day) and citalopram (20 to 40 mg/day) in depressed patients. The studies found that compared to placebo, both escitalopram and citalopram significantly improved depression symptoms in outpatients with moderate to severe depression. But escitalopram treatment lead to significantly greater improvement in depression symptoms compared to citalopram, and the differences were greater in severely depressed patients. The studies were presented here June 26th at the 23rd Congress of the Collegium Internationale Neuro-Psychopharmacologicum (CINP). Selective serotonin reuptake inhibitors (SSRIs) are sometimes not considered as first-line treatments for the most severely depressed patients, noted lead investigator Dr. Jack M. Gorman, of Columbia University College of Physicians and Surgeons in New York, New York. However, escitalopram is the most selective SSRI available and represents an advance in the SSRI class, he said. In the studies, eligible patients were randomly assigned to eight weeks of double-blind treatment following one week of single-blind placebo treatment. Overall, there were 398 patients on placebo, 520 on escitalopram, and 403 on citalopram. The severely depressed subset counted 166 patients on placebo, 211 on escitalopram, and 171 on citalopram. The studies found escitalopram significantly separated from placebo earlier than did citalopram. As well, escitalopram was statistically superior to citalopram at end point. Montgomery-Asberg Depression Rating Scale (MADRS) scores declined by 11.2 in the placebo group, 13.8 in the escitalopram group and 13.1 in the citalopram group at end point (p<0.05 for active treatment versus placebo). Among the severely depressed subset, MADRS scores declined by 12.2 in placebo-treated patients, 16.2 in escitalopram-treated patients (p<0.05 for escitalopram versus citalopram) and 14.4 in citalopram-treated patients. At end point, more than 50 percent of the severely depressed patients treated with escitalopram were MADRS responders (defined as a 50 percent or greater reduction from baseline MADRS score), compared to more than 40 percent of citalopram patients and more than 35 percent of placebo patients. Escitalopram treatment trended strongly toward superiority versus citalopram treatment (p=0.056). The study was supported by Forest Laboratories Inc. E-mail this page to a friend or colleague! To print, use this version