Latest research on Escitalopram

Escitalopram, the S-enantiomer of citalopram, belongs to a class of antidepressant agents known as selective serotonin-reuptake inhibitors (SSRIs). Despite distinct structural differences between compounds in this class, SSRIs possess similar pharmacological activity. As with other antidepressant agents, several weeks of therapy may be required before a clinical effect is seen. SSRIs are potent inhibitors of neuronal serotonin reuptake. They have little to no effect on norepinephrine or dopamine reuptake and do not antagonize α- or β-adrenergic, dopamine D2 or histamine H1 receptors. During acute use, SSRIs block serotonin reuptake and increase serotonin stimulation of somatodendritic 5-HT1A and terminal autoreceptors. Chronic use leads to desensitization of somatodendritic 5-HT1A and terminal autoreceptors. The overall clinical effect of increased mood and decreased anxiety is thought to be due to adaptive changes in neuronal function that leads to enhanced serotonergic neurotransmission. Side effects include dry mouth, nausea, dizziness, drowsiness, sexual dysfunction and headache. Side effects generally occur within the first two weeks of therapy and are usually less severe and frequent than those observed with tricyclic antidepressants. Escitalopram may be used to treat major depressive disorder (MDD) and generalized anxiety disorder (GAD).

Latest findings

The antidepressant types were divided into three categories: i) selective serotonin reuptake inhibitors including Citalopram, EsCitalopram, fluoxetine, Paroxetine, and Sertraline, ii) newer antidepressants such as Bupropion, Venlafaxine, and Mirtazapine, and iii) older anti-depressants such as Amitriptyline, Clomipramine, Imipramine, Milnacipran, Nortriptyline, tianeptine, and Trazodone. [source, 2016]
The most common SSRIs prescribed at baseline were Paroxetine (29.3%), fluoxetine (23.6%), Escitalopram (20.0%), and Sertraline (12.9%). [source, 2016]
The median daily doses of these medications at baseline were 20.0 mg/day for Paroxetine, 10.0 mg/day for Escitalopram, 50.0 mg/day for Sertraline, 20.0 mg/day for fluoxetine, and 60.0 mg/day for Duloxetine. [source, 2016]
The efficacy and the tolerability of Escitalopram, aSSRI and Desvenlafaxine, a non-selective SRI has been well-established. [source, 2016]
Although two SNRIs (Milnacipran and Duloxetine) and four selective serotonin reuptake inhibitors (Fluvoxamine, Paroxetine, Sertraline, and Escitalopram) have been approved in Japan as of August 2015, the maximum dosages for most of these are considerably lower than those used in western countries on the basis of balance between the benefits and risks in the Japanese population. [source, 2016]
Thus, there are very limited studies available directly comparing efficacies of Escitalopram with Desvenlafaxine in treatment of major depression. [source, 2016]
Hence, a preliminary 1-year prospective randomized open label trial comparing efficacy and safety of Escitalopram with Desvenlafaxine in the treatment of major depression was undertaken. [source, 2016]
For example, the maximum dosages approved in the US and Japan, respectively, for the treatment of MDD are as follows: Milnacipran (200 mg/100 mg), Duloxetine (120 mg/60 mg), Fluvoxamine (300 mg/150 mg), Paroxetine (50 mg/40 mg), Sertraline (200 mg/100 mg), and Escitalopram (20 mg/20 mg). [source, 2016]
Patients meeting eligibility criteria at the screening visit were assigned randomly in 1:1 ratio to either receive Escitalopram or Desvenlafaxine. [source, 2016]
In the first 3 weeks, Escitalopram 10 mg/day was given and then 20 mg/day for the next 3 weeks. [source, 2016]