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| |  Escitalopram and Reboxetine Have Equivalent Efficacy in Treatment of Seasonal Affective Disorder: Presented at ECNP By Jenny Powers ISTANBUL, Turkey -- September 15, 2009 -- Patients with seasonal affective disorder (SAD) can be effectively treated with either escitalopram and reboxetine but respond differently to the drugs, which may influence the choice of treatment, according to a study presented on September 13 at the 22nd European College of Neuropsychopharmacology (ECNP) Congress. Edda Pjrek, MD, Department of Psychiatry and Psychotherapy, Medical University of Vienna, Vienna, Austria, presented results of a retrospective study that compared escitalopram and reboxetine for the treatment of SAD. This is the first study to compare selective serotonin reuptake inhibitors (SSRIs) with selective noradrenaline reuptake inhibitors (NARIs) in the treatment of SAD. This study compares data from 2 similar open-label trials that investigated the efficacy of the SSRI escitalopram (1) and the NARI reboxetine (2) in the treatment of SAD. In all, 20 SAD patients received escitalopram 10 to 20 mg, and 15 patients were treated with reboxetine 8 mg for 6 weeks. Patient baseline and post-treatment conditions were evaluated with the Structured Interview Guide for the Hamilton Depression Rating Scale, SAD version (SIGH-SAD); the Clinical Global Impression of Severity (CGI-S) and Improvement (CGI-I); and the Udvalg for Kliniske Undersøgelser (UKU) Side Effect Rating Scale. Statistical analyses included a 2-way mixed-design analysis of variance with Bonferroni corrected post hoc tests. A last observation carried forward procedure was applied for missing data, and Kaplan-Meier survival analysis was used for estimation of response and remission. The study found a positive response to treatment, as reflected by a statistically significant progressive reduction of the SIGH-SAD score in the reboxetine group beginning in the first week (P < .001) and in the escitalopram group during the second week (P < .001); however, at week 6, no significant difference in SIGH-SAD score was seen between the drugs (P = .164). The same response pattern was registered by CGI-S for reboxetine (P < .050) and escitalopram (P < .001), with no significant differences by week 6. The response rates (SIGH-SAD <50% of baseline value: escitalopram 90.0%, reboxetine 86.7%) and remission rates (SIGH-SAD <8: escitalopram 55.0%, reboxetine 60.0%) were not significantly different between the drugs (P = 1.000). Differences were seen in both the patients’ median time to response and time to remission. Those treated with reboxetine had a shorter time to response than those treated with escitalopram (14.0 days; 95% confidence interval [CI], 10.7-17.3; vs 28.0 days; 95% CI, 26.5-29.5; P < .001). The median time to remission was also shorter with reboxetine group (28.0 days; 95% CI, 15.4-40.6; vs 45.0 days; 95% CI, 42.5-47.5; P < .001). However, more severe side effects were also seen with reboxetine treatment than with escitalopram both after beginning treatment (2.4 +- 0.7 vs 0.7 +- 1.0; P < .001) and at the end of the study (1.2 +- 0.7 vs 0.3 +- 0.6; P = .001), as assessed by the UKU scale. Study dropout rates were higher for the reboxetine-treated patients (26.6%) than for escitalopram-treated patients (0.0%; P = .026), although no statistically significant difference was noted for dropouts attributed to side effects (0.0% escitalopram vs 13.3% reboxetine, P = .176). The authors concluded that escitalopram and reboxetine were equally effective in the treatment of SAD. Also, although patients receiving reboxetine had a quicker response, they experienced more severe side effects and had a higher dropout rate. Further controlled studies are needed comparing SSRI and NARI treatment in SAD patients. 1. Pjrek E et al. Pharmacopsychiatry. 2007;40:20-24. [Presentation title: Serotonin or Noradrenalin Reuptake Inhibition in Seasonal Affective Disorder: Escitalopram Versus Reboxetine. Abstract P.2.c.002]
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