Adis, a Wolters Kluwer Business, Auckland, New Zealand.
CNS Drugs. 2010 Sep;24(9):769-96. doi: 10.2165/11204760-000000000-00000.
Escitalopram (escitalopram oxalate; Cipralex, Lexapro), a selective serotonin reuptake inhibitor (SSRI) indicated for the treatment of major depressive disorder (MDD), demonstrates a highly selective and potent, dose-dependent inhibition of the human serotonin transporter, inhibiting serotonin reuptake into presynaptic nerve terminals and thus increasing serotonergic activity in the CNS. With regard to primary endpoints (such as improved scores on the Montgomery-Asberg Depression Rating Scale [MADRS] and the Hamilton Depression Rating Scale [HAM-D]), escitalopram was generally more effective than placebo, at least as effective as citalopram, and generally at least as effective as other comparator drugs, including the SSRIs fluoxetine, paroxetine and sertraline, the serotonin-noradrenaline (norepinephrine) reuptake inhibitors (SNRIs) venlafaxine extended release and duloxetine, and the aminoketone bupropion in adult patients with MDD in short-term, well designed trials. Moreover, it demonstrated a rapid onset of antidepressant action. Escitalopram was also found to be cost effective in several studies, dominating other SSRIs and venlafaxine extended release. Maintenance therapy is commonly required to prevent recurrence of depression. Long-term trials corroborated short-term results, with escitalopram demonstrating greater efficacy than placebo in relapse prevention. Additionally, escitalopram was at least as effective as citalopram, paroxetine and duloxetine in long-term comparative trials. Escitalopram has a predictable tolerability profile with generally mild to moderate and transient adverse events, and a low propensity for drug interactions. Sexual dysfunction with escitalopram treatment appeared to occur to a similar or lower extent to that with paroxetine (another SSRI), to a similar or greater extent to that with the SNRI duloxetine, and to a greater extent than that with the aminoketone bupropion. Thus, escitalopram is an effective and generally well tolerated treatment for moderate to severe MDD. Escitalopram, like other SSRIs, is an effective first-line option in the management of patients with MDD.
依他普仑（草酸依他普仑；喜普妙，来士普），一种选择性 5-羟色胺再摄取抑制剂（SSRI），用于治疗重度抑郁症（MDD），表现出高度选择性和强效的、剂量依赖性的人血清素转运体抑制作用，抑制血清素再摄取入突触前神经末梢，从而增加中枢神经系统中的血清素活性。关于主要终点（如蒙哥马利-阿斯伯格抑郁评定量表 [MADRS] 和汉密尔顿抑郁评定量表 [HAM-D] 评分的改善），依他普仑通常比安慰剂更有效，至少与西酞普兰一样有效，通常至少与其他比较药物一样有效，包括 SSRIs 氟西汀、帕罗西汀和舍曲林、 血清素-去甲肾上腺素（去甲肾上腺素）再摄取抑制剂（SNRI）文拉法辛缓释和度洛西汀，以及氨基酮类药物安非他酮在短期、精心设计的临床试验中治疗成人 MDD。此外，它表现出抗抑郁作用的快速起效。在几项研究中，依他普仑还被发现具有成本效益，优于其他 SSRIs 和文拉法辛缓释剂。维持治疗通常是预防抑郁症复发所必需的。长期试验证实了短期结果，依他普仑在预防复发方面比安慰剂更有效。此外，依他普仑在长期比较试验中与西酞普兰、帕罗西汀和度洛西汀一样有效。依他普仑具有可预测的耐受性特征，通常为轻度至中度和短暂的不良反应，药物相互作用的倾向较低。依他普仑治疗时出现的性功能障碍似乎与帕罗西汀（另一种 SSRI）相似或程度较低，与 SNRI 度洛西汀相似或程度较高，与氨基酮类药物安非他酮程度较高。因此，依他普仑是一种有效且通常耐受性良好的中重度 MDD 治疗药物。依他普仑与其他 SSRIs 一样，是 MDD 患者管理的有效一线选择。
