Priorities in treating depression only.

Physicians treating depression are, on the whole, not entirely satisfied with current antidepressant treatment options. There is a demand for improved therapies with a rapid symptom relief, a high remission rate and greater prevention of recurrence. The remission rate is particularly important since patients with depression not reaching remission have much poorer outcomes than those who do. Several studies have shown that the selective serotonin reuptake inhibitors (SSRIs) and the serotonin and noradrenergic reuptake inhibitors (SNRIs) have higher remission rates than other antidepressant medications. However, data from meta-analyses have suggested that venlafaxine shows higher remission rates than the SSRIs, fluoxetine, fluvoxamine and paroxetine. It is therefore important to examine how the more recently developed SSRIs compare with others in the same drug class and also with SNRIs with regard to symptom relief, remission rate and tolerability. Using data from three pooled studies, the new SSRI escitalopram was compared with the older SSRI citalopram. Escitalopram performed significantly better than citalopram and placebo in terms of percentage responders (defined as a ≥50% decrease of baseline Montgomery and Åsberg Depression Rating Scale [MADRS] score). Furthermore, in a flexible-dose study the remission rate with escitalopram treatment was higher than citalopram during 8 weeks. Remission (defined as MADRS ≤12 at endpoint) in a flexible-dose study was also investigated with escitalopram versus extended release venlafaxine. Overall, the remission rates were similar between the two medications at the end of week 8, but patients on escitalopram achieved sustained remission nearly a week earlier than those on venlafaxine. Higher remission rates were also found with escitalopram compared with venlafaxine in severely ill patients. Furthermore, escitalopram also offered important advantages over venlafaxine with regards to tolerability.