Escitalopram Prevents Relapse in Older Patients With Major Depressive Disorder

University of Kent, Cantorbery, England, United Kingdom
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 Escitalopram was well tolerated with 53 patients (13%) withdrawn as a result of adverse events during the open-label period and three (2%) escitalopram-treated patients and six (4%) placebo-treated patients during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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Available from: Philip Gorwood
    • "Important differences in results were found with ranges of 18 to 82% for placebo and 16 to 80% for citalopram (Roose et al., 2004). Finally, SSRI reduces the relapse rate significantly (Gorwood et al., 2007), known to be higher in elderly patients (Mitchell and Subramaniam, 2005). Non-responders to SSRIs appear to be a subgroup with standard cognitive impairments (Culang et al., 2009). "
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    ABSTRACT: Although psychomotor retardation (PR) and cognitive disfunctioning are essential symptoms of elderly depressed patients, the differential effect of treatment with an SSRI in the elderly on these symptoms has hardly got any attention in studies with objective experimental measures. Since effects appear relatively slower in elderly, this study evaluates the effect on cognitive and psychomotor functioning as compared to mood, on four points during a twelve week follow up of monotreatment with escitalopram. 28 non-demented elderly unipolar depressive patients on 5-20mg escitalopram were compared to 20 matched healthy elderly. All participants underwent a test battery containing clinical depression measures, cognitive measures of processing speed, executive function and memory, clinical ratings of PR, and objective computerized fine motor skill-tests at the start and after 2, 6 and 12 weeks. Statistical analysis consisted of a General Linear Model (GLM) repeated measures multivariate analysis of variance of completers to compare the psychomotor and cognitive outcomes of the two groups. Although, apart from the significant mood effect, no interaction effects were found for the psychomotor and cognitive tasks, the means in general show a trend of differential effects in cognitive and psychomotor functions, with smaller effects and delayed timeframes and with presence of subgroups compared to mood effects. Longer follow up studies are necessary to evaluate differential long term effects. In elderly, moderate effects of SSRI treatment on mood precede slow or limited effects on cognition and psychomotor retardation. Copyright © 2015 Elsevier B.V. All rights reserved.
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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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