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Continuation Treatment with Escitalopram Effective in Preventing Relapse Into An Episode Of Major Depressive Disorder

Continuation treatment with escitalopram, a serotonin reuptake inhibitor, is effective in preventing relapse into an episode of major depressive disorder, new research suggests.

The antidepressant efficacy of escitalopram has been previously demonstrated in acute (8-week) trials in which both escitalopram and citalopram were compared with placebo. However, current antidepressant guidelines suggest 4 to 6 months of continuation treatment to prevent relapse of depression following symptom resolution.

To investigate the efficacy and safety of continuing escitalopram treatment, Mark Hyman Rapaport, MD, with the Cedars-Sinai Medical Center, Los Angeles, California, United States and colleagues conducted an 8-week open-label study in which all patients received escitalopram (10-20 mg/day).

Participants included 502 adult patients diagnosed with DSM-IV major depressive disorder who had completed 8 weeks of randomised double-blind treatment with escitalopram, citalopram, or placebo. They were then entered an 8-week flexible-dose, open-label phase in which all patients received escitalopram (10-20 mg/day).

Patients who responded to the open-label phase of treatment (12 or less on the Montgomery-Asberg Depression Rating Scale [MADRS]) were then 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 a further 36 weeks of double-blind treatment.

A total of 274 evaluable subjects entered the double-blind treatment phase, with 93 receiving placebo and 181 receiving 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%) versus those receiving placebo (40%); (hazard ratio = 0.56; P = .01). In addition, patients receiving escitalopram had significantly lower depression ratings than those of placebo-treated patients.

The researchers note that escitalopram continuation treatment was safe and well tolerated. Discontinuation rates due to adverse events were 7% for the placebo group compared to 4% in those receiving escitalopram.

"The present results extend previously reported observations from acute treatment trials and suggest that continued treatment with escitalopram is safe and effective, " Dr. Rapaport and colleagues conclude. "In this trial, escitalopram treatment led to the consolidation of acute treatment response and the prevention of relapse of depressive episodes," they add.




J Clin Psychiatry 2004;65:44-49. "Escitalopram continuation treatment prevents relapse of depressive episodes"

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