The Pharmaceutical Journal
Vol 269 No 7220 p557
19 October 2002

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Escitalopram has faster action and is better tolerated than venlafaxine

The selective serotonin re-uptake inhibitor escitalopram (Cipralex) achieves remission of depression faster than the serotonin noradrenaline reuptake inhibitor venlafaxine (Efexor XL), according to trial data reported last week.

The study, presented at the European College of Neuropsychopharmacology meeting held in Barcelona, randomised 288 patients with major depressive disorder (MDD) to receive either escitalopram 10–20mg or modified release venlafaxine 75–150mg daily. Sustained response was achieved a mean of 4.6 days faster (P<0.05) and sustained remission 6.6 days faster (P<0.001) for patients treated with escitalopram than for those treated with venlafaxine.

After eight weeks, there was no difference in the number of patients who had responsed to treatment (>50 per cent reduction in the Montgomery-Åsberg depression rating scale total score from baseline) between the two groups.
More patients withdrew after treatment with venlafaxine because of adverse events than after treatment with escitalopram (11 per cent versus 8 per cent), with nausea being the most common side effect in both groups. Presenting the findings, Professor Stuart Montgomery, Imperial College School of Medicine, London, said: “SSRIs have been considered the gold-standard for tolerability but have been challenged by some to be less effective than non-selective treatments such as tricyclics or venlafaxine.”

He continued: “This study has shown that escitalopram is at least as effective as venlafaxine in the treatment of major depressive disorder, but superior in achieving remission earlier and it is significantly better tolerated. Escitalopram’s fast onset of action and good tolerability are important as they should help patients to stay on treatment, to achieve full remission of depression.”
However, Wyeth, manufacturer of Efexor XL, has questioned the interpretation of the data. In a statement the company said: “A considerably larger sample size would have been necessary to distinguish any potential true clinical difference in the two drugs.

“This study was designed purely to determine that one drug wasn’t any worse than another and not whether one drug is better than another.”

The study was supported by Lundbeck.