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For Major Depression, Escitalopram (Lexapro) Achieves Better Risk/Benefit Profile Than Venlafaxine XR (Effexor XR)

By Bruce Sylvester

ATLANTA, GA -- May 31, 2005 -- For the treatment of major depression, escitalopram (Lexapro) achieves a better risk/benefit profile than venlafaxine XR (Effexor XR), researchers here reported on May 24^th at the American Psychiatric Association (APA) Annual Meeting.

"When side-effect risks and treatment benefits are weighed against one another in the population with severe depression, escitalopram looks better for these patients overall," said lead investigator Stuart A. Montgomery, MD, Professor Emeritus of Medicine, Imperial College of Science and Medicine, London, United Kingdom.

Dr. Montgomery and colleagues retrospectively evaluated data from two randomized, double-blind, 8-week trials that compared the efficacy and tolerability of escitalopram to venlafaxine in major depressive disorder.

For their primary outcome measure, the researchers used mean change from baseline in scores on the Montgomery Asberg Depression Rating Scale (MADRS).

In the first study, that of primary-care treatment in Europe, the investigators reported that escitalopram 10 to 20 mg/day (n = 148) was at least as effective as venlafaxine 75 to 150 mg/day (n = 145), and it had a better adverse effects profile.

"Survival analysis of sustained response and sustained remission, showed escitalopram to be significantly superior to venlafaxine (P < .05)," the authors noted.

In the second study, that of depressed outpatients in specialist settings in the United States, escitalopram 20 mg/day (n = 97) was more effective than venlafaxine 225 mg/day (n = 98).

When the researchers evaluated a cohort of 121 severely depressed patients drawn from both studies, patients with MADRS >/=30, escitalopram was more effective than venlafaxine.

Venlafaxine subjects showed a higher overall incidence (85%) of treatment-emergent adverse events than escitalopram subjects (68%). Also, more subjects from the venlafaxine group from the escitalopram group withdrew due to adverse events than (16% vs. 4%; P < .01).

Studies cited:

1. Bielski RJ, Ventura D, Chang C-C: A double-blind comparison of escitalopram and venlafaxine extended release in the treatment of major depressive disorder. J Clin Psych 2004; 65:1190-1196.
2. Montgomery SA, Huusom AKT, Bothmer J: A randomised study comparing escitalopram with venlafaxine XR in primary care patients with major depressive disorder. Neuropsychobiology 2004; 50:57-64.


[Presentation title: Treatment of Major Depressive Disorder With Escitalopram Versus Venlafaxine XR. Abstract NR402]

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