Efficacy and tolerability profile of escitalopram versus other antidepressants in the acute treatment of major depressive disorder: A systematic review and meta-analysis

Aim. The aim of this study was to evaluate the efficacy and tolerability profile of escitalopram versus other commercially available antidepressants in Italy. Methods. The review was based on evidence from clinically controlled randomized trials. Studies on patients of either sex, without age limit, and with a primary diagnosis of major depressive disorder were included; exclusion criteria were psychiatric and organic co-morbidities. Efficacy was measured according to the number of treatment responders (a reduction of at least 50% in scores on a standardized scale between baseline and endpoint). Acceptability was evaluated according to the total number of study drop outs. The results are expressed as relative risk (95% confidence interval) of the total number of randomized patients (intention to treat analysis). Results. Of a total of 137 studies, only 7 controlled randomized trials met the inclusion criteria, yielding a total of 2164 patients. The efficacy of escitalopram was found to be statistically superior only to citalopram; its acceptability was marginally statistically higher than fluoxetine and citalopram. No statistically significant differences emerged versus fluoxetine and venlafaxine. Conclusion. Results suggest a statistically significant better efficacy and tolerability profile for escitalopram versus citalopram; however, owing to the small number of comparative studies conducted so far and the lack of quality evidence, it is too early to draw clinically significant conclusions about the agent's real efficacy and tolerability.