What is the difference between lexapro and citalopram

This analysis was exhaustive because it included all trials in which the maximum dose for escitalopram 20 mg could be administered. According to the cut-off point taken to define severe depression based on the MADRS total score 30 , patients were considered as severely depressed patients and so included in this analysis.

Among them, received escitalopram, received citalopram and received the placebo. The primary efficacy parameter was the mean change from baseline to end of treatment in MADRS total score between escitalopram and citalopram groups, based on last-observation-carried-forward method. Results: Results showed that the mean change from baseline in the MADRS total score was significantly higher in the escitalopram group compared with the citalopram group - Learn what to do, avoid, and how to recognize the signs of suicidal….

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Learn about symptoms, causes, and treatment. Health Conditions Discover Plan Connect. Mental Health. Celexa vs. Lexapro Cost and availability Side effects Drug interactions Warnings Takeaway Introduction Finding the right medication to treat your depression can be difficult.

Drug Features. Brand name Celexa Lexapro What is the generic drug? Cost, availability, and insurance. Side effects. Drug interactions. Use with other medical conditions. Talk with your doctor. Only three antidepressants clomipramine, venlafaxine, escitalopram were found to have two or more studies showing superiority against a standard antidepressant under conditions of fair comparison Montgomery et al.

This meta-analysis examined published data and data available on publicly accessible websites from all studies with both escitalopram and citalopram treatment arms in patients with MDD in order to evaluate the potential superiority of escitalopram and place it in the perspective of a clinically relevant difference.

Key words, including escitalopram AND citalopram AND depression or major depressive disorder or major depressive episode , were specified. Additional studies in any language were sought in reference lists of retrieved articles. Unpublished trials were identified through the Controlled Trials database, www. In addition, the following clinical trial registration sites were searched: www. For most studies, continuous variables were based on the full analysis set FAS , comprising patients that had been randomized to treatment, had received at least one dose of study medication, and had at least one valid post-baseline efficacy assessment.

An analysis was also carried out on the intent-to-treat ITT set, comprising all patients who received at least one dose of study medication. If such measures of variability were not present, they were imputed from either exact p values or p values with sufficiently narrow limits e. In the latter case, the upper limit of the p -value interval was used to impute variability estimates. Because the difference between the two compared groups was supplied along with groupwise sample sizes, and assuming equal variances between the compared groups, the s.

The use of normal fractile leads to a higher estimated s. For these studies, s. This method produced s. Of the articles reporting either of these outcomes, some reported estimates predictions from logistic regression analyses by treatment group, while others reported crude i. In the first case, adjusted estimates were converted to number of patients that, for example, were in remission by multiplying the estimated predictions by the by-treatment FAS sample size.

Hence, the response and remission meta-data consist of both adjusted and unadjusted figures. The numbers of patients responding or in remission, together with by-treatment sample sizes, were extracted from the studies. For studies with more than one dose of escitalopram or citalopram Burke et al.

The difference in mean change from baseline and corresponding s. The responder and remitter rates for each study were converted into log odds ratios and associated standard errors. The log odds ratio and associated s. The NNT is the inverse of the difference between the responder or remitter probabilities of two treatments. With these assumptions, all of the statistical machinery described below applies to the difference of the responder or remitter probability between treatments.

After performing the meta-analysis on the difference between responder or remitter probabilities between treatments and calculating an appropriate confidence interval thereof, the point estimate and the limits of the confidence intervals were back-transformed to an estimated NNT and associated confidence intervals. All p values and confidence intervals are based on two-sided considerations with type I error set to 0.

All studies were RCTs except study 9, which was naturalistic. Two studies did not report response and remission rates studies 1 and 5. Only one study was not published as a peer-reviewed article study 1 , although the data are reported on the Forest website and these data have been included in previous meta-analyses.

Mean dose Esc, Escitalopram; Cit, citalopram. The overall odds ratio for responders was 1. The responder rates were The corresponding NNT for responder was The differences in responder rates in percentage points for each study are shown in Fig.

The remission rates were The corresponding NNT for remission was 5. The differences in remission rates in percentage points for each study are shown in Fig. This meta-analysis of all the publicly available data indicates that escitalopram has superior efficacy compared to citalopram in the treatment of MDD in a patient population including both moderate and severe disorder.

It includes all available studies in MDD that included escitalopram and citalopram treatment arms head-to-head, with an active control, or placebo-controlled and provides further evidence for a statistically significant efficacy advantage of escitalopram over citalopram.

However, a statistically significant difference between two treatments may not reflect clinical benefits that are evident or relevant when treating individual patients. Separate tests are usually applied to the data to test if statistical differences are likely to have clinical relevance. There are several approaches to determining clinical relevance. In regulatory terms the most important are the responder analysis, the remitter analysis and the treatment effect the difference between two treatments in the improvement from baseline to endpoint on a standard assessment scale EMEA, The criteria used to establish a clinically relevant difference have almost all been focused on a comparison of drug and placebo.

Comparing differences between two active treatments applying the same criterion used to define a clinically relevant difference on the pivotal scale between active drug and placebo is very stringent, since this means that the difference to placebo of the superior treatment must be at least twice that of the comparator antidepressant.

The studies included in the present meta-analysis included large regulatory studies sponsored by H. Even if no robust conclusions can be drawn from these smaller studies individually, the results are consistent with those from the larger trials. This is an effectiveness study with an open non-randomized design and the bias of the investigator in the choice of treatment and assessment might have influenced the result. There is some evidence of possible investigator bias in the allocation of patients to different treatments, since the escitalopram group were significantly more severely depressed at baseline than those on citalopram.

This might have been a chance finding but it might also reflect the clinical view, which was already current, that escitalopram was a more effective treatment in severe depression. All effectiveness studies are open to these sorts of biases. Nevertheless, for the sake of completeness, the study was included Anderson, , but was excluded from the meta-analysis of the randomised controlled studies.

The overall treatment difference between escitalopram and citalopram was 1. A direct measure of the clinically relevant difference may be taken from the difference observed between placebo and citalopram. On the basis of an analysis of the positive antidepressant studies submitted to the FDA, Kirsch et al. In the case of citalopram this difference was 1.

In a more recent meta-analysis of placebo controlled studies for all antidepressants, including a range of other non-regulatory studies, the reported difference on HAMD 17 was 1. Since the present analysis included a wide range of non-regulatory studies, a 1.

It could therefore be concluded that this difference is clinically relevant. Since the treatment difference between escitalopram and citalopram was 1. The European Medicines Agency EMEA normally uses a responder analysis to determine whether a statistically significant difference is also clinically relevant. A statistically significant advantage on the responder analysis in favour of an antidepressant compared with placebo is normally considered by the Committee for Medicinal Products for Human Use CMPH to be clinically relevant EMEA, In a review of placebo-controlled antidepressant studies submitted for regulatory approval over a year period, Melander et al.

The present analysis of two antidepressants shows a response advantage of 8. These differences translate into NNTs of approximately 12 for response and six for remission.