COMPARATIVE EFFICACY OF ESCITALOPRAM VERSUS OTHER ANTIDEPRESSANTS IN ADULTS WITH MAJOR DEPRESSIVE DISORDER: A META-ANALYSIS OF RANDOMIZED CONTROLLED TRIALS

PRANAB  DAS; DHRUBAJYOTI BORAH; AYAN PURKAYASTHA; DARADI  DAS

doi:10.22159/ijpps.2025v17i8.55347

Authors

PRANAB DAS Department of Pharmacology, Pragjyotishpur Medical College and Hospital, Ulubari, Guwahati-781016, Assam, India https://orcid.org/0009-0009-0229-3277
DHRUBAJYOTI BORAH Department of Pharmacology, Silchar Medical College and Hospital, Silchar-788014, Assam, India
AYAN PURKAYASTHA Department of Pharmacology, Silchar Medical College and Hospital, Silchar-788014, Assam, India https://orcid.org/0009-0008-6449-4966
DARADI DAS Department of Pharmacology, Pragjyotishpur Medical College and Hospital, Ulubari, Guwahati-781016, Assam, India

DOI:

https://doi.org/10.22159/ijpps.2025v17i8.55347

Keywords:

Major depressive disorder, Escitalopram, Antidepressants, Meta-analysis, Efficacy, Odds ratio, Response, Randomized controlled trials

Abstract

Objective: To assess if escitalopram exhibits greater efficacy in attaining clinical response or remission in adult patients with major depressive disorder (MDD) compared to other frequently prescribed antidepressants, utilising binary outcomes from randomised controlled trials.

Methods: A meta-analysis were performed in accordance with Preferred Reporting Items for Systematic Reviews and Meta-Analyses (PRISMA) 2020 recommendations. Databases such as PubMed, Scopus, Cochrane Library, and Google Scholar were queried for randomised controlled trials (RCTs) and meta-analyses that compared escitalopram with alternative antidepressants in individuals diagnosed with major depressive disorder (MDD). Studies were considered if they presented binary outcomes (response/remission) and/or facilitating the calculation of odds ratios (ORs). A fixed-effect meta-analysis was conducted utilising log-transformed odds ratios (ORs) and confidence interval (CI).

Results: Five qualifying studies were included. Escitalopram showed statistically significant superiority compared to comparators, including duloxetine, paroxetine, sertraline, venlafaxine, fluoxetine, and citalopram. The pooled odds ratio for attaining clinical response or remission was 1.32 (95% confidence interval [CI]: 1.21–1.43), signifying a 32% increased probability of positive outcomes with escitalopram. The forest plot validated consistency among research, with Montgomery et al. (2011) and Wade et al. (2007) demonstrating notably robust results.

Conclusion: Escitalopram seems to be more efficacious than other antidepressants in eliciting response and remission in individuals with Major Depressive Disorder (MDD). This study advocates for its preferential application as a first-line pharmacological drug; however, individual patient considerations should inform ultimate treatment choices.

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References

1. World Health Organization. Depression. In: Geneva: World Health Organization; 2023. Available from: https://www.who.int/news-room/factsheets/detail/depression.

2. Greenberg PE, Fournier AA, Sisitsky T, Pike CT, Kessler RC. The economic burden of adults with major depressive disorder in the United States (2005 and 2010). J Clin Psychiatry. 2015;76(2):155-62. doi: 10.4088/JCP.14m09298, PMID 25742202.

3. National Institute for Health and Care Excellence (NICE). Depression in adults: treatment and management. In: London: NICE; 2022 Jun. (NICE Guideline No. 222). Available from: https://www.nice.org.uk/guidance/ng222. [Last accessed on 10 Jun 2025].

4. Sanchez C, Reines EH, Montgomery SA. A comparative review of escitalopram paroxetine and sertraline: are they all alike? Int Clin Psychopharmacol. 2014;29(4):185-96. doi: 10.1097/YIC.0000000000000023, PMID 24424469.

5. Cipriani A, Santilli C, Furukawa TA, Signoretti A, Nakagawa A, McGuire H. Escitalopram versus other antidepressive agents for depression. Cochrane Database Syst Rev. 2009;(2):CD006532. doi: 10.1002/14651858.CD006532.pub2, PMID 19370639.

6. Kennedy SH, Andersen HF, Lam RW. Efficacy of escitalopram in the treatment of major depressive disorder compared with conventional selective serotonin reuptake inhibitors and venlafaxine XR: a meta-analysis. J Psychiatry Neurosci. 2006;31(2):122-31. PMID 16575428.

7. Auquier P, Robitail S, Llorca PM, Rive B. Comparison of escitalopram and citalopram efficacy: a meta-analysis. Int J Psychiatry Clin Pract. 2003;7(4):259-68. doi: 10.1080/13651500310003408, PMID 24930412.

8. Kirino E. Escitalopram for the management of major depressive disorder: a review of its efficacy, safety and patient acceptability. Patient Prefer Adherence. 2012 Dec 4;6:853-61. doi: 10.2147/PPA.S22495, PMID 23271894.

9. Kennedy SH, Andersen HF, Thase ME. Escitalopram in the treatment of major depressive disorder: a meta-analysis. Curr Med Res Opin. 2009;25(1):161-75. doi: 10.1185/03007990802622726, PMID 19210149.

10. Montgomery S, Hansen T, Kasper S. Efficacy of escitalopram compared to citalopram: a meta-analysis. Int J Neuropsychopharmacol. 2011;14(2):261-8. doi: 10.1017/S146114571000115X, PMID 20875220.

11. Boulenger JP, Huusom AK, Florea I, Baekdal T, Sarchiapone M. A comparative study of the efficacy of long-term treatment with escitalopram and paroxetine in severely depressed patients. Curr Med Res Opin. 2006;22(7):1331-41. doi: 10.1185/030079906X115513, PMID 16834832.

12. Wade A, Gembert K, Florea I. A comparative study of the efficacy of acute and continuation treatment with escitalopram versus duloxetine in patients with major depressive disorder. Curr Med Res Opin. 2007;23(7):1605-14. doi: 10.1185/030079907x210732, PMID 17559755.

13. Chattar KB, Karve AV, Subramanyam A, Tondare SB. Prescription pattern analysis of antidepressants in psychiatric outpatient department of tertiary care hospital in India. Asian J Pharm Clin Res. 2016;9(4):77-9.

14. Sabu L, Yacob M, Singh H. Drug utilization pattern of psychotropic drugs in psychiatric outpatient department in a tertiary care teaching hospital. Asian J Pharm Clin Res. 2017;10(1):259-61. doi: 10.22159/ajpcr.2017.v10i1.15112.

15. Venkataraman R, Rayamajhi M, Islam S, NN. Prescribing pattern of psychotropic agents in rural tertiary care teaching hospital. Asian J Pharm Clin Res. 2018;11(3):155-62. doi: 10.22159/ajpcr.2018.v11i3.23063.

16. Cipriani A, Furukawa TA, Salanti G, Chaimani A, Atkinson LZ, Ogawa Y. Comparative efficacy and acceptability of 21 antidepressant drugs for the acute treatment of adults with major depressive disorder: a systematic review and network meta-analysis. Lancet. 2018;391(10128):1357-66. doi: 10.1016/S0140-6736(17)32802-7, PMID 29477251.

17. Wu T, Song F, Cao W, Liu C, Jia S. Comparative efficacy of antidepressant medication for adolescent depression: a network meta-analysis and systematic review. BMC Psychiatry. 2025;25(1):471. doi: 10.1186/s12888-025-06941-x, PMID 40349006.

18. Zhao K, Wang Y, Liu Q, Yu Z, Feng W. Efficacy comparison of five antidepressants in treating anxiety and depression in cancer and non-cancer patients. Front Neurosci. 2024 Oct 30;18:1485179. doi: 10.3389/fnins.2024.1485179, PMID 39539490.

19. Raju P, Qian H, Arumugham SS, Kesavan M, Wong H, YC JR. Escitalopram vs bupropion as adjunctive treatment for acute bipolar I depression: a multi-center open label trial. Int J Neuropsychopharmacol. 2025;28 Suppl 1:i120-1. doi: 10.1093/ijnp/pyae059.208, PMCID PMC11814593.

20. Fujii Y, Asakura S, Mitsui N. Pharmacotherapy of social anxiety disorders in children and adolescents. Int J Neuropsychopharmacol. 2025;28 Suppl 1:i105-6. doi: 10.1093/ijnp/pyae059.181, PMCID PMC11815113.

21. Rohde C, Hieronymus F, Ostergaard SD. A target trial emulation comparing the antidepressant effectiveness of selective serotonin reuptake inhibitors (SSRIs), highlighting the importance of patient-related confounding by indication. Acta Psychiatr Scand. 2024;150(4):198-208. doi: 10.1111/acps.13729, PMID 38994727.

22. Ouazana Vedrines C, Hoertel N, Lesuffleur T, Denis P, Olfson M, Blanco C. Sex differences in antidepressant acceptability according to filled prescription sequences in a nationwide cohort study. J Clin Psychiatry. 2024;85(4):23m15128. doi: 10.4088/JCP.23m15128, PMID 39630084.

23. Ankushe RD, Deshmukh VS, Chepure AH, Jaju JB. A comparative study of efficacy, safety and onset of action of vilazodone with escitalopram in patients of major depressive disorder at tertiary care hospital. Asian J Pharm Clin Res. 2022 Sep;15(9):113-7. doi: 10.22159/ajpcr.2022.v15i9.44812.

24. Kushbu D, Riyaz NM, Basha OA, Ahmed SA. Comparative study of efficacy and safety of escitalopram with escitalopram and clonazepam in patients suffering from generalized anxiety disorder a prospective randomized control study. Int J Curr Pharm Res. 2025;17(3):24-8. doi: 10.22159/ijcpr.2025v17i3.55046.