Escitalopram

Escitalopram, sold under the brand names Cipralex and Lexapro, among others, is an antidepressant of the selective serotonin reuptake inhibitor (SSRI) class.[2] Escitalopram is mainly used to treat major depressive disorder or generalized anxiety disorder.[2] It is taken by mouth.[2]

Common side effects include trouble sleeping, nausea, sexual problems, and feeling tired.[2] More serious side effects may include suicide in people under the age of 25.[2] It is unclear if use during pregnancy or breastfeeding is safe.[3] Escitalopram is the (S)-stereoisomer of the earlier medication citalopram, hence the name escitalopram.[2]

Escitalopram was approved for medical use in the United States in 2002.[2] In the United States the wholesale cost is about $2.04 per month as of 2017.[4] In the United Kingdom, as of 2018, generic escitalopram is around 1/20th as costly as the proprietary version.[5] Escitalopram is sometimes replaced by twice the dose of citalopram.[6] In 2016 it was the 26th most prescribed medication in the United States with more than 25 million prescriptions.[7]

Medical uses[edit]

Escitalopram has FDA approval for the treatment of major depressive disorder in adolescents and adults, and generalized anxiety disorder in adults.[2] In European countries and UK, it is approved for depression (MDD) and anxiety disorders, these include: general anxiety disorder (GAD), social anxiety disorder (SAD), obsessive-compulsive disorder (OCD), and panic disorder with or without agoraphobia. In Australia it is approved for major depressive disorder.[8][9][10]

Depression[edit]

Escitalopram was approved by regulatory authorities for the treatment of major depressive disorder on the basis of four placebo controlled, double-blind trials, three of which demonstrated a statistical superiority over placebo.[11]

Controversy existed regarding the effectiveness of escitalopram compared with its predecessor, citalopram. The importance of this issue followed from the greater cost of escitalopram relative to the generic mixture of isomers of citalopram, prior to the expiration of the escitalopram patent in 2012, which led to charges of evergreening. Accordingly, this issue has been examined in at least 10 different systematic reviews and meta analyses. As of 2012, reviews had concluded (with caveats in some cases) that escitalopram is modestly superior to citalopram in efficacy and tolerability.[12][13][14][15]

A 2011 review concluded that second-generation antidepressants appear equally effective, although they may differ in onset and side effects.[16] Treatment guidelines issued by the National Institute of Health and Clinical Excellence and by the American Psychiatric Association generally reflect this viewpoint.[17][18]

In 2018, a systematic review and network meta-analysis comparing the efficacy and acceptability of 21 antidepressant drugs showed escitalopram to be one of the most effective.[19]