Nine studies were included in the review (2,009 patients): eight RCTs and one non-randomised study. Length of study ranged from four to 24 weeks. Reported withdrawals due to adverse events ranged from 1.4% to 10.4%, where reported.
Treatment difference: There was a statistically significantly greater mean treatment difference with escitalopram compared with citalopram in the trials that reported MADRS (mean difference 1.7, 95% CI 0.8 to 2.06; six RCTs). Sensitivity analysis indicated that the results were still significant when the non-randomised study was included, but results were not significant in the two trials that reported HAMD.
Response and remission: There was a statistically significantly greater response rate of 72.3% with escitalopram compared with 63.9% with citalopram (OR 1.44, 95% CI 1.18 to 1.75, NNT=11.9; eight RCTs). There was also a statistically significantly greater remission rate of 61.6% with escitalopram compared with 44% with citalopram (OR 1.86, 95% CI 1.46 to 2.36, NNT=5.7; four RCTs).