Newer Antidepressants: Review of Efficacy and Safety of Escitalopram and Duloxetine

Background: Two antidepressants with different mechanisms of action, escitalopram and duloxetine, have recently been developed for the treatment of major depressive disorder. This article reviews the available controlled data on these agents with regard to efficacy, safety, and tolerability. Method: We identified four 8-week, double-blind, placebo-controlled studies of escitalopram in the acute treatment of major depression. Three of the studies involved an active comparator, citalopram. We identified 6 placebo-controlled studies of duloxetine in major depressive disorder. Two of the studies included fluoxetine as an active comparator, and 2 included paroxetine as an active comparator. Results: A review of the data from the controlled studies supports the efficacy of both escitalopram and duloxetine in the treatment of patients with major depression. Three of the 4 escitalopram studies were positive, and 1 was a failed study. Four of the 6 duloxetine studies were positive. Both escitalopram and duloxetine performed better than at least 1 selective serotonin reuptake inhibitor comparator. The safety and tolerability profiles of both drugs are quite benign. The reported incidence of treatment-emergent adverse events was somewhat lower with escitalopram than with duloxetine, with the possible exception of sexual dysfunction. Discontinuations due to adverse events were lower for escitalopram than for duloxetine, although rates were comparable with higher doses of escitalopram (20 mg/day). Conclusion: Both escitalopram and duloxetine are useful in the treatment of major depressive disorder.