Major Depressive Disorder
Escitalopram oxalate is used for the acute and maintenance treatment of major depressive disorder in adults and adolescents 12-17 years of age.
Efficacy of escitalopram for the acute management of major depression in adults was established in 3 placebo-controlled studies of 8 weeks' duration in adult outpatients who met DSM-IV criteria for major depressive disorder. In these studies, 10- and 20-mg daily dosages of escitalopram were more effective than placebo in improving scores on the Montgomery Asberg Depression Rating Scale (MADRS), the Hamilton Rating Scale for Depression (HAM-D), and the Clinical Global Impression Improvement and Severity of Illness Scale. Escitalopram also was more effective than placebo in improving other aspects of depressive disorder, including anxiety, social functioning, and overall quality of life. Substantial improvement in MADRS and HAM-D scores was noted in patients receiving either dosage of escitalopram compared with those receiving placebo after 1-2 weeks of therapy. In addition, escitalopram dosages of 10-20 mg daily appeared to be at least as effective as racemic citalopram dosages of 20-40 mg daily. No age-, race-, or gender-related differences in efficacy were noted in these studies.
Efficacy of escitalopram for the acute management of major depressive disorder in adolescents 12-17 years of age was established in an 8-week, flexible-dose, placebo-controlled study in outpatients who met DSM-IV criteria for major depressive disorder. Escitalopram-treated patients in this study demonstrated substantially greater improvement on the Children's Depression Rating Scale-Revised (CDRS-R) compared with those receiving placebo. Efficacy of escitalopram in the acute treatment of major depressive disorder in adolescents was also established on the basis of extrapolation from an 8-week, flexible-dose, placebo-controlled study with racemic citalopram 20-40 mg daily. In this outpatient study conducted in children and adolescents 7-17 years of age who met DSM-IV criteria for major depressive disorder, citalopram-treated patients demonstrated substantially greater improvement on the CDRS-R compared with those receiving placebo; the positive results in this trial came largely from the adolescent subgroup. Two additional flexible-dose, placebo-controlled depression studies (one for escitalopram in patients 7-17 years of age and one for citalopram in adolescents) did not demonstrate efficacy.
In a longer-term study, 274 adults with major depressive disorder who had responded to escitalopram 10 or 20 mg daily during an initial 8-week, open-label, flexible dosage treatment phase were randomized to continue escitalopram at the same dosage or receive placebo for up to 36 weeks of observation for relapse in the double-blind phase. Relapse during the double-blind phase was defined as an increase in the MADRS total score to 22 or greater or discontinuance due to insufficient clinical response. Escitalopram-treated patients experienced a substantially longer time to relapse of depression compared with those receiving placebo. In addition, more placebo recipients relapsed compared with patients receiving escitalopram (cumulative relapse rates were approximately 40 and 26%, respectively).
Although efficacy of escitalopram as maintenance therapy in adolescent patients has not been systematically evaluated, such efficacy can be extrapolated from adult data along with comparisons of escitalopram pharmacokinetic parameters in adults and adolescent patients.
The manufacturers state that if escitalopram is used for extended periods, the need for continued therapy should be reassessed periodically.
There is some evidence that escitalopram may offer some clinical advantages compared with citalopram or other selective serotonin-reuptake inhibitors (e.g., increased efficacy, more rapid onset of therapeutic effect, fewer adverse effects); however, additional studies are needed to confirm these initial findings.
For further information on use of SSRIs in the treatment of major depressive disorder and considerations in choosing the most appropriate antidepressant agent for a particular patient,
Generalized Anxiety Disorder
Escitalopram is used in the management of generalized anxiety disorder in adults. Efficacy for the management of generalized anxiety disorder was established in 3 multicenter, flexible-dose, placebo-controlled studies of 8-weeks' duration in adult outpatients who met DSM-IV criteria for generalized anxiety disorder. In these studies, patients receiving 10-20 mg daily of escitalopram had substantially greater mean improvements in scores on the Hamilton Anxiety Scale (HAM-A) than those receiving placebo.
For further information on the treatment of generalized anxiety disorder, .