Escitalopram Prevents Relapse in Older Patients With Major Depressive Disorder

From INSERM U675, Paris, France.
American Journal of Geriatric Psychiatry (Impact Factor: 4.24). 08/2007; 15(7):581-93. DOI: 10.1097/01.JGP.0000240823.94522.4c
Source: PubMed


The present study investigated the efficacy and tolerability of escitalopram in the prevention of relapse of major depressive disorder (MDD) in older patients who had responded to acute treatment with escitalopram.
A total of 405 patients who were aged 65 years or older with a primary diagnosis of MDD (according to Diagnostic and Statistical Manual of Mental Disorders, Fourth Edition criteria) and a Montgomery-Asberg Depression Rating Scale (MADRS) total score of 22 or more received 12-week, open-label escitalopram 10 or 20 mg per day treatment. Remitters (MADRS </=12) were randomized to 24-week double-blind treatment with escitalopram or placebo. The primary efficacy parameter was the time to relapse, defined as either an increase in MADRS total score to 22 or more or lack of efficacy as judged by the investigator.
Three hundred five patients achieved remission and were randomly assigned to treatment with escitalopram (N = 152) or placebo (N = 153). The primary analysis showed a clear beneficial effect of escitalopram relative to placebo on the time to relapse (log-rank test, chi(2) = 27.6, df = 1, p <0.001). The risk of relapse was 4.4 times higher for placebo- than for escitalopram-treated patients (chi(2) test, chi(2) = 22.9, df = 1, p <0.001). Significantly fewer escitalopram-treated patients relapsed (9%) compared with placebo (33%) (chi(2) test, chi(2) = 27.1, df = 1, p <0.001). Escitalopram was well tolerated with 53 patients (13%) withdrawn as a result of adverse events during the open-label period and three (2%) escitalopram-treated patients and six (4%) placebo-treated patients during double-blind treatment (not significant). The overall withdrawal rate, excluding relapses, was 7.2% for escitalopram and 8.5% for placebo during the double-blind period (not significant).
Escitalopram was effective in preventing relapse of MDD in older patients and was well tolerated as continuation treatment.

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    • "The model also assumed no additional resource use for AEs beyond drugs to treat the AEs; however, this assumption is justified with generally mild-level severity of the AEs associated with SSRIs, typically not associated with other health-care resource use. Another assumption was a similar probability of relapse between the treatment arms, justified by the observations in clinical studies of the two drugs [17] [18] [19] [20]. "
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    • "Forty-six papers met inclusion criteria, constituting 49 samples and 3,454 patients (Klerman et al., 1974; Coppen et al., 1978; Stein et al., 1980; van Praag and de Haan, 1980; Davidson and Raft, 1984; Harrison et al., 1986; Montgomery et al., 1988, 1993, 1998, 2004; Georgotas et al., 1989; Robinson et al., 1991; Doogan and Caillard, 1992; Claghorn and Feighner, 1993; Montgomery and Dunbar, 1993; Anton et al., 1994; Robert and Montgomery, 1995; Bremner and Smith, 1996; Entsuah et al., 1996; Kocsis et al., 1996, 2007; Stewart et al., 1997; Keller et al., 1998; Reimherr et al., 1998; Terra and Montgomery, 1998; Reynolds et al., 1999; Alexopoulos et al., 2000; Rouillon et al., 2000; Schmidt et al., 2000; Gilaberte et al., 2001; Hochstrasser et al., 2001; Klysner et al., 2002; Wilson et al., 2003; Detke et al., 2004; Simon et al., 2004; Amsterdam and Bodkin, 2006; Kamijima et al., 2006; Lustman et al., 2006; McGrath et al., 2006; Perahia et al., 2006, 2009; Gorwood et al., 2007; Cheung et al., 2008; Dobson et al., 2008; Emslie et al., 2008; Rickels et al., 2010). The information extracted from each study is listed in Table A1 in the Appendix. "
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    Frontiers in Psychology 07/2011; 2:159. DOI:10.3389/fpsyg.2011.00159 · 2.80 Impact Factor
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    • "Hence, in the absence of a placebo control, these rates of remission should not be construed as being entirely related to escitalopram treatment. In addition to the clinician-rated MADRS, the geriatric depression scale was also used in the original study [12]. This patient self-rating scale was only assessed at baseline, at randomisation and at last assessment. "
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    BMC Geriatrics 01/2011; 11:2. DOI:10.1186/1471-2318-11-2 · 1.68 Impact Factor
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