The onset of effect for escitalopram and its relevance for the clinical management of depression

Wade, Alan G; Andersen, H.

doi:10.1185/030079906x148319

Cited by 37 publications

(17 citation statements)

References 19 publications

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“…For escitalopram, it takes 2 weeks before 5-HT neuronal firing returns to control levels in rats, but for most SSRIs, it takes at least 3 weeks, suggesting a faster onset of action for escitalopram, possibly due to its action at the allosteric site (El Mansari et al , 2005; Mnie-Filali et al , 2007). This is consistent with the indication of escitalopram having a faster clinical onset than other SSRIs (Lepola et al , 2004; Kasper et al , 2006; Wade and Andersen, 2006). Among other neurochemical changes during antidepressant treatment, the neurotropin brain-derived neurotrophic factor (BDNF) was recently reviewed (Zhong et al , 2012a).…”

Section: Mechanisms Related To Efficacy and Tolerabilitysupporting

confidence: 88%

A comparative review of escitalopram, paroxetine, and sertraline

Sanchéz

Reines

Montgomery

2014

International Clinical Psychopharmacology

234

139

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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.

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Section: Mechanisms Related To Efficacy and Tolerabilitysupporting

confidence: 88%

A comparative review of escitalopram, paroxetine, and sertraline

Sanchéz

Reines

Montgomery

2014

International Clinical Psychopharmacology

234

139

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“…Escitalopram also has a fast onset of action (Kasper et al 2006;Wade and Friis 2006). More recently, a number of reviews and meta-analyses of the clinical efficacy of escitalopram in depression have been published.…”

Section: Introductionmentioning

confidence: 98%

Escitalopram, an antidepressant with an allosteric effect at the serotonin transporter—a review of current understanding of its mechanism of action

Zhong¹,

Haddjeri

Sanchéz

2011

Psychopharmacology

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“…Assumptions on the performance of citalopram were based on the performance of escitalopram in a previous study in patients with a baseline MADRS score of 28.7 (Wade & Friis Andersen, 2006). To account for loss to follow-up (21 %), the target recruitment number of patients was 165.…”

Section: Sample Sizementioning

confidence: 99%

Citalopram plus low-dose pipamperone versus citalopram plus placebo in patients with major depressive disorder: an 8-week, double-blind, randomized study on magnitude and timing of clinical response

et al. 2011

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Background. Selective serotonin reuptake inhibitors take several weeks to achieve their full antidepressant effects. Post-synaptic 5-HT 2A receptor activation is thought to be involved in this delayed therapeutic effect. Pipamperone acts as a highly selective 5-HT 2A /D 4 antagonist when administered in low doses. The purpose of this study was to compare citalopram 40 mg once daily plus pipamperone 5 mg twice daily (PipCit) versus citalopram plus placebo twice daily for magnitude and onset of therapeutic effect.Method. An 8-week, randomized, double-blind study in patients with major depressive disorder was carried out.Results. The study population comprised 165 patients (citalopram and placebo, n=82 ; PipCit, n=83) with a mean baseline Montgomery-Asberg Depression Rating Scale (MADRS) score of 32.6 (S.D.=5.5). In the first 4 weeks, more citalopram and placebo than PipCit patients discontinued treatment (18 % v. 4 %, respectively, p=0.003). PipCit patients had significantly greater improvement in MADRS score at week 1 [observed cases (OC), p=0.021 ; last observation carried forward (LOCF), p=0.007] and week 4 (LOCF, p=0.025) but not at week 8 compared with citalopram and placebo patients. Significant differences in MADRS scores favoured PipCit in reduced sleep, reduced appetite, concentration difficulties and pessimistic thoughts. Mean Clinical Global Impression-Improvement scores were significantly improved after 1 week of PipCit compared with citalopram and placebo (OC and LOCF, p=0.002).Conclusions. Although the MADRS score from baseline to 8 weeks did not differ between groups, PipCit provided superior antidepressant effects and fewer discontinuations compared with citalopram and placebo during the first 4 weeks of treatment, especially in the first week.

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The onset of effect for escitalopram and its relevance for the clinical management of depression

Abstract: Onset of treatment response at 2 weeks is an important indicator of subsequent remission at 8 weeks. It would therefore be a reasonable clinical recommendation that if patients fail to show a measurable clinical improvement within 2 weeks, a dose increase should be considered at this time.

Cited by 37 publications

References 19 publications

A comparative review of escitalopram, paroxetine, and sertraline

A comparative review of escitalopram, paroxetine, and sertraline

Escitalopram, an antidepressant with an allosteric effect at the serotonin transporter—a review of current understanding of its mechanism of action

Citalopram plus low-dose pipamperone versus citalopram plus placebo in patients with major depressive disorder: an 8-week, double-blind, randomized study on magnitude and timing of clinical response

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