Depression escitalopram

Robinson, Robert G., Ricardo E. Jorge, David J. Moser, Laura Acion, Ana Solodkin, Steven L. Small, Pasquale Fonzetti, Mark Hegel and Stephan Arndt, Escitalopram and Problem-Solving Therapy for Prevention of Poststroke Depression A Randomized Controlled T rial , Journal of the American Medical Association 299, no. 20 (2008) 2391-400 Rogers, Carl, On Becoming a Person A Therapist s View of Psychotherapy, London Constable, 1961... 

Since the introduction of the first approved SSRI, fluoxetine (1) in 1987 [9], a number of SSRIs have been developed for the treatment of depression [2], Currently, the five most commonly prescribed SSRIs are fluoxetine, escitalopram (2, S-enantiomer of citalopram), sertraline (3), paroxetine (4) and fluvoxamine (5). Recent effort in the clinical development of new SSRIs has focused on the treatment of premature ejaculation (PE) by taking advantage of the ejaculation-delaying side effects of SSRIs [10]. Although SSRIs have been prescribed off-label to treat this condition, an SSRI with rapid onset of action and rapid clearance could be preferred for on-demand treatment of PE [11,12]. Dapoxetine (LY210448, 6), an... 

The current SSRIs in the United States inclnde fluoxetine, fluvoxamine, sertraline (Zoloft), paroxetine (Paxil), citalopram (Celexa), and escitalopram (Lexapro). All effectively treat major depression. In addition, one or more of the SSRIs has been shown effective in the treatment of dysthymic disorder, the depressive phase of bipolar disorder, premenstrual dysphoric disorder, panic disorder, social phobia, obsessive-compnlsive disorder, bnlimia nervosa, and binge-eating disorder. 

Depression Citalopram, escitalopram, fluoxetine, paroxetine (immediate- and controlled-release), sertraline. 

Due to the frequent unwanted effects and, in case of tranylcypromine, the numerous and dangerous interactions MAO-inhibitors are more and more replaced by the much less problematic SSRIs. Compounds belonging to this group are citalopram, escitalopram, fluoxetine, paroxetine and sertraline. They are used clinically in the therapy of depression, bulimia and obsessive-compulsive disorders. All SSRIs show a slow onset of action (1-2 weeks). They may induce insomnia and weight loss. The antidepressant ven-lafaxine inhibits both, serotonin and noradrenaline re-uptake and might therefore additionally induce hypertension. 

Waugh J, Goa KL (2003) Escitalopram a review of its use in the management of major depressive and anxiety disorders. CNS Drugs 17 343-362 Williams DD, McBride A (1998) Benzodiazepines time for reassessment. Br J Psychiatry 173 361-362... 

The selective serotonin reuptake inhibitors (SSRIs) represent a chemically diverse class of agents that have as their primary action the inhibition of the serotonin transporter (SERT) (Figure 30-3). Fluoxetine was introduced in the United States in 1988 and quickly became one of the most commonly prescribed medications in medical practice. The development of fluoxetine emerged out of the search for chemicals that had high affinity for monoamine receptors but lacked the affinity for histamine, acetylcholine, and adrenoceptors that is seen with the tricyclic antidepressants (TCAs). There are currently six available SSRIs, and they are the most common antidepressants in clinical use. In addition to their use in major depression, SSRIs have indications in GAD, PTSD, OCD, panic disorder, PMDD, and bulimia. Fluoxetine, sertraline, and citalopram exist as isomers and are formulated in the racemic forms, whereas paroxetine and fluvoxamine are not optically active. Escitalopram is the S enantiomer of citalopram. As with all antidepressants,... 

The selective serotonin re-uptake inhibitors (SSRIs) that are currently available are fluoxetine, fluvoxamine, paroxetine, sertraline, citalopram, and escitalopram. They are widely marketed and are in many countries a major alternative to tricyclic antidepressants in the treatment of depression. The SSRIs are structurally diverse, but they are all inhibitors of serotonin uptake, with much less effect on noradrenaline. They have slight or no inhibitory effect on histaminergic, adrenergic, serotonergic, dopaminergic, and cholinergic receptors (1). 

Citalopram is a racemic bicyclic phthalane derivative and is a highly selective serotonin re-uptake inhibitor with minimal effects on noradrenaline and dopamine neuronal reuptake. Inhibition of 5-HT re-uptake by citalopram is primarily due to escitalopram, the active S-enantiomer of citalopram (1). One would expect escitalopram to be twice as potent as citalopram but otherwise not to differ significantly from the racemic mixture. However, escitalopram is marketed as being more efficacious than citalopram because, it is argued, the inactive R-isomer present in the racemate actually inhibits binding of the S-enantiomer to its site of action, the serotonin transporter. In some, but not all, clinical trials escitalopram has been statistically superior to citalopram in terms of speed of onset of therapeutic action and improvement on depression rating scales. The clinical significance of these differences is debatable (2). 

Escitalopram was efficacious in patients with major depressive disorder in short-term, placebo-controlled trials, three of which included citalopram as an active control, and in a 36-week study in the prevention of relapse in depression (7). It has also been used to treat generalized anxiety disorder, panic disorder, and social anxiety disorder. Results also suggest that, at comparable doses, escitalopram demonstrates clinically relevant and statistically significant superiority to placebo treatment earlier than citalopram. The most common adverse events associated with escitalopram include nausea, insomnia, disorders of ejaculation, diarrhea, dry mouth, and somnolence. Only nausea occurred in more than 10% of patients taking escitalopram. 

Murdoch D, Keam SJ. Escitalopram a review of its use in the management of major depressive disorder. Drugs 2005 65 2379-404. 

A 22-year-old man who had had ADHD since the age of 8 years took methylphenidate, and had an adequate response for 14 years (52). However, his symptoms worsened and he switched from methylphenidate to mixed amfetamine salts 20 mg bd. A month later he continued to have difficulty in focusing on tasks, and the dosage was eventually increased to 45 mg tds over several weeks, with symptomatic improvement. However, 5 days later, he awoke feeling nauseated and agitated and had choreiform movements of his face, trunk, and limbs. He had also taken escitalopram 10 mg/day for anxiety and depression for 2 months before any changes in his ADHD medications. He was treated with intravenous diphenhydramine, lora-zepam, and diazepam without improvement in the chorea. Amfetamine was withdrawn and 3 days later his chorea abated. He restarted methylphenidate and the movement disorders did not recur. 

Some postmenopausal women s depression will respond better to escitalopram plus estrogen augmentation than to escitalopram alone... 

Baldwin DS. Escitalopram efficacy and tolerability in the treatment of depression. Hosp Med. 2002 63 668-71. 

Venlafaxine extended-release, a serotonin-norepinephrine reuptake inhibitor (SNRI), alleviates anxiety in patients with and without co-morbid depression. The reduction in psychic symptoms of anxiety and tension is not accompanied by significant reductions in somatic symptoms. Venlafaxine (dosed once daily) was effective at doses of 150 and 225 mg for 2 months in patients with GAD, and efficacy was maintained for an additional 6 months of therapy." Paroxetine was significantly more effective than placebo at achieving response in 62% and 68% of patients at 20 and 40 mg daily, respectively, after 2 months. Remission occurred in 30% and 36% of patients taking 20 and 40 mg of paroxetine, respectively." Escitalopram was more efficacious than placebo in three 8-week trials in patients with GAD. In a four paraUel-group comparison, diazepam and trazodone were found to be equivalent in anxiolytic activity (remission rates of 66% and 69%, respectively) compared with placebo (47% remission rate), but rmipramine s rate of remission (73%) exceeded that of the other three treatments. ... 

Patients treated with paroxetine or sertraline showed improvement in anxiety and avoidance symptoms and a decrease in disability. Daily doses up to 60 mg of paroxetine and 200 mg of sertraline were well tolerated, and emergent adverse effects were similar to those of depression trials (e.g., nausea, sexual dysfunction, sweating, and somnolence). The onset of effect was delayed 4 to 8 weeks, and maximum benefit was often not observed until 12 weeks or longer. Sertraline is also effective in disabled patients suffering from the marked to severe form of generalized SAD. Limited data suggest that citalopram, escitalopram, and fluvoxamine are also effective in treating SAD. Fluoxetine was not effective in SAD. ... 

Escitalopram is a selective serotonin reuptake inhibitor that inhibits the CNS neuronal nptake of serotonin, potentiating serotonergic activity. It is indicated in the major depressive disorders and generalized anxiety. 

The adverse events profile for escitalopram is similar to that observed with Ri-citalopram in both major depression and anxiety disorders. Discontinuation rates due to adverse events were similar in patients receiving escitalopram or placebo in several trials. Nausea and ejaculatory problems were reported in both fully published trials in patients with major depression. In addition, diarrhea, insomnia, dry mouth, headache, and upper respiratory tract infections were experienced by patients receiving escitalopram, although the incidence of these events was not significantly higher than in patients receiving placebo. The recommended dose of escitalopram for the treatment of major depression is 10 mg/day, which, depending on the individual patient response, may be titrated up to 20 mg/day. 

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