Escitalopram continuation treatment prevents relapse of depressive episodes.

Abstract

BACKGROUND:

Current guidelines for antidepressant use recommend 4 to 6 months of continuation treatment to prevent relapse of depression following symptom resolution. This study evaluates the efficacy and safety of continuation escitalopram treatment.

METHOD:

Outpatients diagnosed with DSM-IV major depressive disorder (male or female, aged 18 to 81 years) who had completed 8 weeks of randomized double-blind treatment with escitalopram, citalopram, or placebo entered an 8-week flexible-dose, open-label phase in which all patients received escitalopram (10-20 mg/day). This study was initiated November 3, 1999, and completed April 5, 2001. Patients who met responder criteria (score of < or = 12 on the Montgomery-Asberg Depression Rating Scale [MADRS]) were randomly assigned in a 2:1 ratio to escitalopram (at the dose each patient was receiving at the end of the open-label phase) or placebo for 36 weeks of double-blind treatment. The primary efficacy variable was time to depression relapse (defined as MADRS score > or = 22 or discontinuation due to an insufficient therapeutic response) from the start of the double-blind treatment phase.

RESULTS:

A total of 502 patients received open-label escitalopram treatment and had at least 1 MADRS assessment. A total of 274 evaluable subjects entered the double-blind treatment phase; 93 received placebo and 181 received escitalopram. Time to depression relapse was significantly longer (p =.013) and the cumulative rate of relapse was significantly lower in patients who received escitalopram (26% escitalopram vs. 40% placebo; hazard ratio = 0.56; p =.01). Escitalopram-treated subjects had significantly lower depression ratings than those of placebo-treated patients. Escitalopram continuation treatment was safe and well tolerated. Discontinuation rates due to adverse events were 7% for the placebo group and 4% for the escitalopram-treated group.

CONCLUSION:

Continuation treatment with escitalopram is effective in preventing relapse into an episode of major depressive disorder.

• Authors: Mark Hyman Rapaport, Anjana Bose, Hongjie Zheng
• Journal: The Journal of clinical psychiatry (J Clin Psychiatry) Vol. 65 Issue 1 Pg. 44-9 (Jan 2004) ISSN: 0160-6689 [Print] United States
• PMID: 14744167 (Publication Type: Clinical Trial, Journal Article, Multicenter Study, Randomized Controlled Trial, Research Support, Non-U.S. Gov't)

Chemical References

• Antidepressive Agents, Second-Generation
• Placebos
• Citalopram

Topics

• Administration, Oral
• Adolescent
• Adult
• Aged
• Aged, 80 and over
• Antidepressive Agents, Second-Generation (administration & dosage, adverse effects, pharmacology)
• Citalopram (administration & dosage, adverse effects, pharmacology)
• Depressive Disorder (drug therapy, psychology)
• Double-Blind Method
• Drug Administration Schedule
• Female
• Humans
• Male
• Middle Aged
• Placebos
• Prognosis
• Psychiatric Status Rating Scales
• Recurrence
• Treatment Outcome