"These are exciting results," said Dr Baldwin, School of Medicine, University of Southampton, UK. "Patients very often present to their doctors with symptoms of both depression and anxiety, and sometimes it is difficult to decide which is the primary problem. Treatments that are effective and well-tolerated in both depression and GAD are therefore most welcome. The evidence for the effectiveness of escitalopram in GAD is particularly impressive, as this is the fourth study out of four placebo controlled studies, which have shown a clear advantage for the active medication", he concluded.
The twelve-week, randomised, fixed dose study compared the efficacy and tolerability of escitalopram to placebo, using paroxetine as an active reference. Significantly better therapeutic effect was seen for both 10mg and 20mg escitalopram than for placebo (p<0.05). Escitalopram 10mg was also significantly (p<0.05) more effective than paroxetine 20mg.
The proportion of patients in remission at Week 12 was statistically significantly greater in the escitalopram 5mg, 10mg, and 20mg groups than in the placebo group (p<0.05), and significantly greater in the escitalopram 10mg group than in the paroxetine 20mg group (p<0.05). The remission rate at Week 12 for paroxetine 20mg was not significantly higher than that for placebo. As paroxetine to a large extent has been considered to be a standard treatment for many anxiety disorders, this further emphasises the strong results in favour of escitalopram.
Overall, the incidence of treatment-emergent adverse events was similar across treatment groups.
Generalized anxiety disorder (GAD) is a relatively common disease, affecting approximately 8% of the worldwide population at some point in their life.1 GAD turns daily life into a state of worry, anxiety, and fear. Excessive thinking and dwelling on the "what ifs" characterizes this anxiety disorder.
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Antidepressant Cipralex (Escitalopram) At Least As Effective, Significantly Faster Acting and Better Tolerated than Venlafaxine
Cipralex / Lexapro (escitalopram) is at least as effective and better tolerated in the treatment of patients with Major Depressive Disorder (MDD), according to a review of two comparative studies presented today at the ECNP (European College of Neuropsychopharmacology) in Stockholm. Furthermore, escitalopram achieves sustained remission one week faster than venlafaxine XR and in severe MDD, escitalopram (20mg) showed significantly superior efficacy compared to venlafaxine (225mg).
"These results are important because they show we have a treatment at our disposal which is effective without sacrificing the good side-effect profile obviously preferred by patients," commented study author Professor Stuart A. Montgomery, Imperial College School of Medicine, London, United Kingdom. "The ideal combination for any first line treatment is good efficacy and good tolerability - this study shows that escitalopram has all the potency of the non selective SNRIs combined with the good tolerability of the conventional SSRIs," he concluded.
The two eight-week, randomised, double blind studies, which were conducted across eight European countries and the United States respectively, compared the efficacy and tolerability of escitalopram to that of venlafaxine XR.
The studies encompass dosages covering both primary and secondary care treatment settings (escitalopram 10-20mg/day and venlafaxine XR 75-150mg/day for the European study and escitalopram 20mg/day and venlafaxine XR 225mg/day for the U.S. study).
Both studies showed that escitalopram was at least as efficacious as venlafaxine XR, which is perceived as a very effective antidepressant. In addition, escitalopram was consistently better tolerated.
Importantly, the study in primary care showed that patients treated with escitalopram achieved sustained remission on average one week earlier than the venlafaxine treated patients. Furthermore, in the secondary care study, escitalopram (20mg) showed significantly superior efficacy compared to venlafaxine (225mg) among the patients who were severely ill at study entry.
Major depressive disorder is a serious and widespread medical disorder that affects millions of people each year. The global burden of depression has increased by nearly 20 per cent in ten years (British Journal of Psychiatry, May 2004).