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Vol. 50, No. 1, 2004
Issue release date: June 2004
Neuropsychobiology 2004;50:57–64

A Randomised Study Comparing Escitalopram with Venlafaxine XR in Primary Care Patients with Major Depressive Disorder

Montgomery S.A. · Huusom A.K.T. · Bothmer J.
aImperial College School of Medicine, London, UK; bH. Lundbeck A/S, Copenhagen, Denmark; cLundbeck GmbH & Co., Hamburg, Germany

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This 8-week, randomised, double-blind study compared the efficacy and tolerability of escitalopram to that of venlafaxine XR in primary care patients with major depressive disorder. The efficacy of escitalopram (10– 20 mg; n = 148) was similar to venlafaxine XR (75– 150 mg; n = 145), based on mean change from baseline to week 8 in Montgomery and Åsberg Depression Rating Scale total score. In ad hoc analyses, escitalopram-treated patients achieved sustained remission significantly faster than did venlafaxine-treated patients. More venlafaxine-treated patients had nausea, constipation, and increased sweating (p < 0.05). When treatment was completed after 8 weeks, significantly more venlafaxine-treated patients had discontinuation symptoms (p < 0.01). Thus escitalopram treatment was similar to venlafaxine treatment with respect to efficacy and was better tolerated by patients in primary care.

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  1. Coryell W, Scheftner W, Keller M, Endicott J, Maser J, Klerman GL: The enduring psychosocial consequences of mania and depression. Am J Psychiatry 1993;150:720–727.
  2. Montgomery SA: Clinically relevant effect sizes in depression. Eur Neuropsychopharm 1994;4:283–284.
  3. Bostwick JM, Pankratz VS: Affective disorders and suicide risk: A reexamination. Am J Psychiatry 2000;157:1925–1932.
  4. Lin EH, Von Korff M, Katon W, et al: The role of the primary care physician in patients’ adherence to antidepressant therapy. Med Care 1995;33:67–74.
  5. Katon W, Rutter C, Ludman EJ, et al: A randomized trial of relapse prevention of depression in primary care. Arch Gen Psychiatry 2001;58:241–247.
  6. Gumnick JF, Nemeroff CB: Problems with currently available antidepressants. J Clin Psychiatry 2000;61(suppl 10):5–15.
  7. Bauer M, Whybrow PC, Angst J, Versiani M, Moller HJ: World Federation of Societies of Biological Psychiatry (WFSBP) Guidelines for Biological Treatment of Unipolar Depressive Disorders. Part 1. Acute and continuation treatment of major depressive disorder. World J Biol Psychiatry 2002;3:5–43.
  8. Thase ME, Entsuah AR, Rudolph RL: Remission rates during treatment with venlafaxine or selective serotonin reuptake inhibitors. Br J Psychiatry 2001;178:234–241.
  9. Owens MJ, Knight DL, Nemeroff CB: Second-generation SSRIs: Human monoamine transporter binding profile of escitalopram and R-fluoxetine. Biol Psychiatry 2001;50:345–350.
  10. Gorman J, Korotzer A, Su G: Efficacy comparison of escitalopram and citalopram in the treatment of major depressive disorder: Pooled analysis of placebo-controlled trials. CNS Spectrums 2002;7(suppl 4):40–44.
  11. Lepola UM, Loft H, Reines EH: Escitalopram (10 to 20 mg/day) is effective and well tolerated in a placebo-controlled study in depression in primary care. Int Clin Psychopharmacol 2003;18:211–217.
  12. Auquier P, Robitail S, Llorca P-M, Rive B: Comparison of escitalopram and citalopram efficacy: A meta-analysis. Int J Psychiatry Clin Prac 2003;7:259–268.

    External Resources

  13. Cunningham LA, for the Venlafaxine XR 208 Study Group: Once-daily venlafaxine extended release (XR) and venlafaxine immediate release (IR) in outpatients with major depression. Ann Clin Psychiatry 1997;9:157–164.
  14. Wade A, Lemming OM, Hedegaard KB: Escitalopram 10 mg/day is effective and well tolerated in a placebo-controlled study in depression in primary care. Int Clin Psychopharmacol 2002;17:95–102.
  15. Rudolph RL, Feiger AD: A double-blind, randomised, placebo-controlled trial of once-daily venlafaxine extended release (XR) and fluoxetine for the treatment of depression. J Affect Disord 1999;56:171–181.
  16. ICH: ICH Harmonised Tripartite Guideline E6. Guideline for Good Clinical Practice. 1996.
  17. APA: Diagnostic and Statistical Manual of Mental Disorders, ed 4. Washington, American Psychiatric Association, 1994.
  18. Montgomery SA, Åsberg M: A new depression scale designed to be sensitive to change. Br J Psychiatry 1979;134:382–389.
  19. Hamilton M: Rating scale for depression. J Neurol Neurosur Psychiatry 1960;23:56–62.
  20. Hamilton M: Development of a rating scale for primary depressive illness. Br J Soc Clin Psychol 1967;6:278–296.
  21. Rosenbaum JF, Fava M, Hoog SL, et al: Selective serotonin reuptake inhibitor discontinuation syndrome: A randomised clinical trial. Biol Psychiatry 1998;44:77–87.

    External Resources

  22. Montgomery SA, Rasmussen JGC, Tanghøj P: A 24-week study of 20 mg citalopram, 40 mg citalopram, and placebo in the prevention of relapse of major depression. Int Clin Psychopharmacol 1993;8:181–188.
  23. Montgomery S, Roberts A, Patel AG: Placebo-controlled efficacy of antidepressants in continuation treatment. Int Clin Psychopharmacol 1994;9(suppl 1):49–53.
  24. Pérez V, Gilaberte I, Faries D, Alvarez E, Artigas F: Randomised, double-blind, placebo-controlled trial of pindolol in combination with fluoxetine antidepressant treatment. Lancet 1997;349:1594–1597.
  25. Bielski R, Ventura D, Chang C, Korotzer A: Double-blind comparison of escitalopram and venlafaxine XR in the treatment of major depressive disorder. Eur Neuropsychopharmacol 2003;13(suppl 4):S262.
  26. Montgomery SA: Alternatives to placebo-controlled trials in psychiatry. ECNP Consensus Meeting, September 26, 1996, Amsterdam. Eur Neuropsychopharmacol 1999;9:265–269.
  27. Linden M, Ludewig K, Munz T, Dierkes W: Dosage finding and outcome of venlafaxine treatment in psychiatric outpatients and inpatients: Results of a drug utilization observation study. Pharmacopsychiatry 2003;36:197–205.
  28. Abdelmawla AH, Langley RW, Szabadi E, Bradshaw CM: Comparison of the effects of venlafaxine, desipramine, and paroxetine on noradrenaline- and methoxamine-evoked constriction of the dorsal hand vein. J Clin Pharmacol 1999;48:345–354.
  29. Bitsios P, Szabadi E, Bradshaw CM: Comparison of the effects of venlafaxine, paroxetine and desipramine on the papillary light reflex in man. Psychopharmacology 1999;143:286–292.
  30. Kasper S, el Giamal N, Hilger E: Reboxetine: the first selective noradrenaline re-uptake inhibitor. Exp Opin Pharmacother 2000;1:771–782.
  31. Hindmarch I, Kimber S, Cockle SM: Abrupt and brief discontinuation of antidepressant treatment: Effects on cognitive function and psychomotor performance. Int Clin Psychopharmacol 2000;15:305–318.
  32. Michelson D, Fava M, Amsterdam J, Apter J, Londborg P, Tamura R, Tepner RG: Interruption of selective serotonin reuptake inhibitor treatment. Double-blind, placebo-controlled trial. Br J Psychiatry 2000;176:363–368.
  33. Fava M, Mulroy R, Alpert J, Nierenberg AA, Rosenbaum JF: Emergence of adverse events following discontinuation of treatment with extended-release venlafaxine. Am J Psychiatry 1997;154:1760–1762.

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