Escitalopram maintenance treatment for prevention of recurrent depression: A randomized, placebo-controlled trial

Abstract

Background: Major depressive disorder is a recurrent illness that often requires maintenance antidepressant treatment. Escitalopram is a selective serotonin reuptake inhibitor (SSRI) that has shown efficacy in both acute and continuation treatment of major depressive disorder. The current trial examined the efficacy of maintenance escitalopram treatment in preventing depression recurrence in patients who responded to acute SSRI therapy. Method: Patients with recurrent DSM-IV defined major depressive disorder (≥2 previous episodes; baseline Montgomery-Asberg Depression Rating Scale [MADRS] score≥22) who had responded (MADRS score≤12) to acute open-label treatment (8 weeks) with 1 of 4 SSRIs (fluoxetine, sertraline, paroxetine, or citalopram) received open-label, flexible-dose continuation treatment (16 weeks) with escitalopram (10-20 mg/day). At the end of continuation treatment, patients maintaining response criteria were randomly assigned to 52 weeks of double-blind, fixed-dose maintenance treatment with escitalopram (10 or 20 mg/day) or placebo. Recurrence was defined as a MADRS score≥22 or insufficient therapeutic response during the double-blind phase. The study was conducted between October 16, 2000, and February 4, 2003. Results: A total of 234 patients who responded to acute open-label treatment with 1 of 4 SSRIs received at least 1 dose of open-label escitalopram continuation treatment. Of 164 patients who completed escitalopram continuation treatment, 139 were randomly assigned to doubleblind maintenance treatment with escitalopram (N=73) or placebo (N=66). Mean baseline MADRS scores at the start of the maintenance phase were<5 for both the placebo- and escitalopram-treatment groups. Time to recurrence was significantly longer in patients who received maintenance treatment with escitalopram compared with patients switched to placebo (hazard ratio=0.26, 95% CI=0.13 to 0.52, p<.001). Long-term escitalopram treatment was well tolerated. Conclusion: Maintenance treatment with escitalopram was well tolerated and significantly reduced the risk for recurrence of depression. Patients with few residual symptoms following continuation treatment with escitalopram experienced a high rate of depression recurrence when switched to placebo, demonstrating the need for maintenance therapy of recurrent major depressive disorder beyond 4 to 6 months of initial symptom resolution even if few residual symptoms are present. (PsycINFO Database Record (c) 2016 APA, all rights reserved)

Accession Number: 2007-07420-015. PMID: 17196058 Other Journal Title: Diseases of the Nervous System. Partial author list: First Author & Affiliation: Kornstein, Susan G.; Department of Psychiatry, Virginia Commonwealth University, Richmond, VA, US, skornste@vcu.edu. Release Date: 20070827. Correction Date: 20160919. Publication Type: Journal (0100), Peer Reviewed Journal (0110). Format Covered: Electronic. Document Type: Journal Article. Language: English. Conference Information: American Psychiatric Association, 157, May, 2004, New York, NY, US. Conference Note: Data included in this article have been presented at the aforementioned conference and also at the 44th annual meeting of the New Clinical Drug Evaluation Unit, June 1-4, 2004, Phoenix, Ariz; and the 56th annual meeting of the American Psychiatric Association Institute on Psychiatric Services, October 6-10.2004, Atlanta, Ga. Major Descriptor: Drug Therapy; Maintenance Therapy; Recurrent Depression; Relapse Prevention; Serotonin Reuptake Inhibitors. Minor Descriptor: Treatment Effectiveness Evaluation. Classification: Clinical Psychopharmacology (3340). Population: Human (10); Male (30); Female (40). Location: US. Age Group: Adulthood (18 yrs & older) (300); Young Adulthood (18-29 yrs) (320); Thirties (30-39 yrs) (340); Middle Age (40-64 yrs) (360); Aged (65 yrs & older) (380). Tests & Measures: Hamilton Rating Scale for Depression DOI: 10.1037/t04100-000; Montgomery-Asberg Depression Rating Scale DOI: 10.1037/t04111-000. Methodology: Clinical Trial; Empirical Study; Quantitative Study. References Available: Y. Page Count: 9. Issue Publication Date: Nov, 2006.