Title: Effect of Baseline Severity on Antidepressant Efficacy of Escitalopram and Milnacipranat Tertiary Heath Care Center
Authors: Meghna Shinde, Pooja Reddy, Mohit Kulmi, Chhaya Goyal
DOI: https://dx.doi.org/10.18535/jmscr/v6i4.116
Abstract
Background: The intent of this prospective, open labelled study was to determine the relationship between baseline depression symptom severity and treatment efficacy for Escitalopram selective serotonin reuptake inhibitors (SSRI) in comparison with Milnacipran, dual serotonin noradrenaline reuptake inhibitors (SNRI) in the treatment of major depressive disorder.
Methods: Outpatients (N=120) of Psychiatry with diagnosed ICD-10 major depressive episode and having score of ≥8 on 21-item Hamilton Depression Rating Scale (HDRS) were further divided according to their severity of depression as defined by 21-HDRS score of ≥23 as very severely depressed, 19-22 as severely depressed, 14-18 as moderately depressed and 8-13 as mildly depressed patients. These patients were assigned to receive escitalopram, 10–20 mg/day (54 patients) and milnacipran 50-100 mg(66 patients), for a 8 week treatment period with follow up at 2nd, 4th & 8th week of initiating the treatment. The patients with various grades of depression in each group were assessed and compared for efficacy in terms of response (decrease of ≥50% in HDRS scores) and remission (HDRS score of ≤7).
Results: Escitalopram achieved highest response and remission among very severely depressed patients i.e. 94.18% and 76.40% respectively whereas Milnacipran showed maximum response and remission among patients with severe depression i.e.85.7% and 50% respectively. Escitalopram showed comparable response in mild to moderate grades and greater response in severe grades of depression whereas remission was significantly higher with Escitalopram in all grades of depressed patients relative to Milnacipran.
Conclusion: Escitalopram is more efficacious than Milnacipran in all grades of depression.
Keywords- Escitalopram, Milnacipran, SSRI, SNRI, HDRS
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