Pre-clinical studies, active-control clinical trials and meta-analyses indicate that escitalopram (S-citalopram) might be more effective than citalopram, the racemic mixture of S- and R-citalopram. The present study aimed to confirm the superior efficacy of escitalopram over citalopram. A double-blind, randomized clinical trial was performed in which general practitioners and psychiatrists compared fixed doses of escitalopram (20 mg/day) with citalopram (40 mg/day) over 8 weeks in outpatients with major depressive disorder (MDD) [baseline Montgomery–Asberg Depression Rating Scale (MADRS) score ≥30]. Primary efficacy parameter was change from baseline to last assessment in the MADRS total score. Out of 138 (aged 44.1±10.9 years; initial MADRS score 36.3±4.8) and 142 (aged 46.2±11.1 years; initial MADRS score 35.7±4.4) evaluable patients who were randomized to escitalopram and citalopram, respectively, six and 15 withdrew prematurely (P=0.05). The MADRS score decreased more in the escitalopram than in the citalopram arm (–22.4±12.9 versus –20.3±12.7; P<0.05). There were more treatment responders with escitalopram (76.1%) than with citalopram (61.3%, P<0.01). Adjusted remitter rates were 56.1% and 43.6%, respectively (P<0.05). Tolerability was similar in both groups. This randomized double-blind trial confirms that escitalopram has a superior effect to citalopram in MDD.
aDépartement de Pharmacologie
bINSERM U657, Université Victor Segalen, Bordeaux
cCHU de Bordeaux, Bordeaux
dService de Psychiatrie Adulte, Hôpital Charles Perrens, Bordeaux
eADIM, Lyon, France
Conflict of interest: Funding for this study was provided by H. Lundbeck A/S through an unrestricted grant.
Correspondence and requests for reprints to Nicholas Moore, Department of Pharmacology, Université Victor Segalen, Bordeaux II, 146, rue Léo-Saignat, 33076 Bordeaux cedex, France
Received 24 January 2005 Accepted 9 February 2005