A Cochrane review [Abstract] 1 included 22 studies with a total of at least 6246 subjects with acute phase of major depression. Escitalopram (10 to 20 mg/day in 21 trials) was compared with another SSRI (citalopram, fluoxetine, paroxetine, sertraline, 14 trials) or newer antidepressive agent (venlafaxine, bupropion and duloxetine, 8 trials). The most commonly used primary outcome was change from baseline on Montgomery Asberg Depression Rating Scale (MADRS). Follow-up time ranged from 6 to 24 weeks. Escitalopram was shown to be more effective than citalopram in achieving acute response (6-12 weeks, OR 0.67, 95% CI 0.50 to 0.85, 6 studies) but there was no difference in follow-up response (16-24 weeks, OR 0.96, 95% CI 0.60 to 1.56, 1 study). Escitalopram was also more effective than citalopram in achieving acute phase remission (OR 0.57, 95% CI 0.36 to 0.90, p = 0.02; 6 studies). There was no difference in the adverse event rate. There was no different in acute phase response or remission between escitalopram and fluoxetine, paroxetine, sertraline, bupropion, duloxetine or venlafaxine. Escitalopram was found to be more efficacious than fluoxetine in reduction of depressive symptoms (SMD -0.17, 95% CI -0.32 to -0.03, p = 0.02; 3 studies). Significantly fewer patients using escitalopram withdrew from trials due to any cause compared with patients using duloxetine (OR 0.62, 95% CI 0.38 to 0.99, 3 studies). There were no differences in tolerability between escitalopram and other antidepressants.
Comment: The quality of evidence is downgraded by potential reporting bias (nearly all studies sponsored by the escitalopram manufacturer) and study quality (inadequate allocation concealment, more than 20% loss of follow-up).
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