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Re: One person's argument for Escitalopram

Posted by linkadge on November 7, 2010, at 7:12:27

In reply to Re: One person's argument for Escitalopram, posted by Alexanderfromdenmark on November 7, 2010, at 4:55:31

Of course, you're going to expect me to make some criticisms, so here goes:

First of all, his initial statement "but they're highly effective" is highly flawed. Large scale, placebo controlled meta analysis simply do not support the notion that SSRIs are "highly effective" in the general depressed population.

1) The first study's researchers have financial ties to Lundbeck. Also, no placebo analysis.

2) The second study's researchers have financial ties to Lundbeck. No placebo analysis.

3) The third study (IMHO) is a bit misleading. The total change in MADRS score was similar between paroxetine and escitalopram. Sure, there may have been some subgroup advanatages for escitalopram, but because the total MADRS scores were similar, there must have been some (unmentioned) subgroup advantages for paroxetine as well. Also, no placebo analysis.

4) I'm skeptical of this study because I have not seen the whole study. What doses of medications were used? Also, the study is meaningless because there was apparently no rating scale for "improvement". The outcome just says a certain number of patients experienced "improvement". I would think there would be a tendancy to report an "improvement" (regardless of how small or insignificant) to please researchers. It also appears that this is a proof of concept study (i.e. no placebo arm) again, meaningless.

What about the meta analysis which show that escitalopam is *not* infact superior to citalopram?

http://www.ncbi.nlm.nih.gov/pubmed/14665791

Also keep in mind that a *lot* of escitalopram studies have been funded by Lundbeck. I think there may be some advantages of escitalopram in terms of side effects and that is why the placebo analysis is so important. It could be that escitalopram is performing as well as the placebo (due to fewer side effects) yet other treatments are performing worse. Escitalopram is just the new kid on the block.

Linkadge


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