Comparison of escitalopram and citalopram efficacy: A meta-analysis

OBJECTIVE Escitalopram is a new selective serotonin reuptake inhibitor (SSRI) indicated for the treatment of major depressive disorder (MDD) and panic disorder. Escitalopram is the therapeutically active enantiomer of citalopram. Its efficacy in the treatment of MDD was compared to that of citalopram. METHODS A quantitative meta-analysis was applied to 1262 patients in four randomised clinical trials; the comparison was based on response rate and mean change from baseline in the Montgomery-Åsberg depression rating scale (MADRS) total score at week 8. Complementary analyses were performed on early MADRS change from baseline (week 1), in very severely depressed patients (baseline MADRS total score ≥35) and on the influence of the level of severity at baseline. RESULTS Compared with citalopram, escitalopram-treated patients showed significantly higher response rates and increased mean change from baseline in MADRS at weeks 1 and 8. The superiority of escitalopram over citalopram was more pronounced in very severely depressed patients. This superiority was further shown to increase with degree of severity of the depression. The robustness of meta-analysis results was supported by sensitivity analyses. The clinical superiority of escitalopram versus citalopram is consistent with the results of preclinical pharmacological studies. CONCLUSION Escitalopram was shown to be an effective therapeutic treatment for MDD, presenting significant advantages over citalopram.