A comparative review of escitalopram, paroxetine, and sertraline

Abstract

It is known that newer antidepressants, such as the selective serotonin reuptake inhibitors (SSRIs), provide advantages in tolerability over antidepressants such as the tricyclics. However, even within the SSRI class, differences in efficacy or tolerability exist between the individual drugs. Among the three most widely prescribed SSRIs are paroxetine, sertraline, and escitalopram. Escitalopram is commonly referred to as an SSRI, but also has well-documented allosteric properties, and thus can be further classed as an allosteric serotonin reuptake inhibitor. All three antidepressants are efficacious compared with placebo, but there is evidence that escitalopram is more effective than a range of other antidepressants. There are no direct data to regard either paroxetine or sertraline as a superior antidepressant. Escitalopram is superior compared with paroxetine, which has a less favorable tolerability profile. Paroxetine is associated with cholinergic muscarinic antagonism and potent inhibition of CYP2D6, and sertraline has moderate drug interaction issues in comparison with escitalopram. Overall, as an allosteric serotonin reuptake inhibitor that is somewhat different from classical SSRIs, escitalopram is the first choice judged by combined efficacy and tolerability, and nonclinical data have offered possible mechanisms through which escitalopram could be more efficacious, based on its interaction with orthosteric and allosteric binding sites at the serotonin transporter.

Emerging mechanisms and treatments for depression beyond SSRIs and SNRIs

“…Similarly, SNRIs show differences in potency for SERT vs. NET with venlafaxine having a preference for SERT over NET, and duloxetine being a more balanced drug with respect to 5-HT and NE reuptake inhibitory potencies [4]. These distinct pharmacological properties may lead to different clinical efficacy and/or tolerability profiles [4,5]. However, possibly due to a lack of validated biomarkers that can reliably predict a patient's response to a given antidepressant, it appears that only 50% of patients diagnosed with MDD go into clinical remission using treatments from these two drug classes regardless of the drug chosen [6].…”

A case of acute pelvic pain responding to escitalopram but not to anti-inflammatory drugs

“…Although a review showed that escitalopram may be more effective than sertraline [7], this can be applied to depression but not to acute pelvic pain. To our knowledge, there are no clinical reports specifically investigating the effects of antidepressants on acute pelvic pain.…”

Evidence-Based Selection and Use of Antidepressants in Psychiatric Practice

“…The relatively fast onset of the therapeutic response, the ease of selecting the minimum therapeutic dose, the good tolerance, safety, and effi cacy of the treatment of DD of different structures and severities in different conditions, the potential for improving patients' social functioning and quality of life, and conservation of resources allow SSRI, including escitalopram, to be regarded as fi rst-choice antidepressants [80,85,86] close to the "ideal" [35] because of the optimum balance of tolerance and clinical effi cacy. It is important to study how satisfactory treatment is [87] and to clarify the dynamics of patients' quality of life associated with treatment compliance, as well as the real resource-sparing potential of antidepressants, including the antisuicidal and antiaggressive effects and decreases in the family burden of care; the contribution of psychosocial interventions on the background of rational pharmacotherapy should be considered.…”