Sixteen trials (n=4,602 patients) were included in the review (individual patient data were available for 4,549 patients).
Escitalopram versus all comparators: For all patients, escitalopram was associated with a statistically significant reduction of 1.1 points on the Montgomery-Asberg Depression Rating Scale (MADRS; 95% CI 0.6 to 1.6; 16 trials). When compared with placebo, this was 2.3 points (95% CI 1.4 to 3.1; five trials). Significantly higher response (OR 1.33, 95% CI: 1.15 to 1.53) and remission rates (OR 1.22, 95% CI 1.06 to 1.40) were reported for patients receiving escitalopram. In severely depressed patients, the mean reduction on the MADRS was 1.8 points (95% CI 1.1 to 2.5). Again, significantly higher response (OR 1.60, 95% CI 1.33 to 1.94) and remission rates (OR 1.39, 95% CI 1.15 to 1.68) were reported in this sub-group.
Escitalopram versus selective serotonin reuptake inhibitors (SSRIs): For all patients, escitalopram was associated with a statistically significant reduction of 0.9 points on the MADRS (95% CI 0.3 to 1.5). Response rates were significantly greater in the escitalopram group. For specific SSRIs, statistical significance remained only for the comparison with citalopram (mean treatment difference 1.2 points, 95% CI 0.3 to 2.1; five trials), with response and remission rates significantly greater in the escitalopram group. In severely depressed patients, the mean treatment difference compared with all SSRIs on the MADRS was 1.4 points (95% CI 0.6 to 2.2), and statistical significance remained in the comparison with citalopram. Response rates were significantly greater in the escitalopram groups.
Escitalopram versus serotonin/noradrenaline reuptake inhibitors (SNRIs): For all patients, escitalopram was associated with a statistically significant reduction of 1.7 points on the MADRS (95% CI 0.5 to 2.8). In severely depressed patients, this was 2.9 points (95% CI 1.4 to 4.4). Response and remission rates for both groups were significantly higher in favour of escitalopram. Further results are presented in the paper for analyses of escitalopram versus individual SNRIs.
Sensitivity analyses did not materially influence the main findings. Higher incidences of adverse events were reported for SSRIs and SNRIs compared to escitalopram. Higher withdrawal rates at eight weeks were noted for patients receiving comparator drugs (16 trials).