Escitalopram Research Articles

Recurrence of Major Depressive Disorder Following a Switch from Escitalopram to St. John's Wort: A Case Report

OZET: Major depresif bozuklukta essitalopram'dan sari kantaron'a gecilmesini izleyen yineleme: Bir olgu sunumu Ulkemizde daha cok sari kantaron, yurt disinda ise St. John's wort olarak bilinen hypericum perforatum bitkisinden elde edilen ekstreler, ozellikle Almanca konusulan ulkelerde major depresyon tedavisinde yaygin olarak kullanilmaktadir. Bu maddelerin major depresyonun idame tedavisindeki etkinligi hakkindaki veriler sinirlidir. Bu olgu sunumunda yineleyici major depresif bozuklugu olup, otimik donemde iken idame tedavisi olarak kullandigi essitalopramin yerine sari kantaron kullanmaya baslamasinin ardindan depresyonu yineleyen bir kadin hasta bildirilmektedir.

Antidepressants and changes in concentration of endocannabinoids and N-acylethanolamines in rat brain structures.

The endocannabinoid (eCB) system has recently been implicated in both the pathogenesis of depression and the action of antidepressants. Here, we investigated the effect of acutely or chronically administering antidepressants [imipramine (IMI) (15 mg/kg), escitalopram (ESC) (10 mg/kg), and tianeptine (10 mg/kg)] on the levels of both eCBs [anandamide (AEA) and 2-arachidonoylglycerol (2-AG)] and N-acylethanolamines (NAEs) [palmitoylethanolamide (PEA) and oleoylethanolamide (OEA)] in various rat brain regions. We also examined the ability of the acute and chronic administration of N-acetylcysteine (NAC) (a mucolytic drug; 100 mg/kg) or URB597 (a fatty acid amide hydrolase inhibitor; 0.3 mg/kg), which have both elicited antidepressant activity in preclinical studies, to affect eCB and NAE levels. Next, we determined whether the observed effects are stable 10 days after the chronic administration of these drugs was halted. We report that the chronic administration of all investigated drugs increased AEA levels in the hippocampus and also increased both AEA and 2-AG levels in the dorsal striatum. NAE levels in limbic regions also increased after treatment with IMI (PEA/OEA), ESC (PEA), and NAC (PEA/OEA). Removing chronic ESC treatment for 10 days affected eCB and NAE levels in the frontal cortex, hippocampus, dorsal striatum, and cerebellum, while a similar tianeptine-free period enhanced accumbal NAE levels. All other drugs maintained their effects after the 10-day washout period. Therefore, the eCB system appears to play a significant role in the mechanism of action of clinically effective and potential antidepressants and may serve as a target for drug design and discovery.

The influence of Hatha yoga as an add-on treatment in major depression on hypothalamic–pituitary–adrenal-axis activity: A randomized trial

ObjectivesThe impact of Hatha yoga as add-on treatment to quetiapine fumarate extended release (QXR) or escitalopram (ESC) in depressed patients on hypothalamic–pituitary–adrenal (HPA) axis activity was assessed. Methods60 inpatients suffering from major depressive disorder (MDD) according to DSM-IV were randomized for a 5 week treatment with Yoga or not (control group) and with either QXR (300 mg/day) or ESC (10 mg/day). Serial dexamethasone/corticotropin releasing hormone (DEX/CRH) tests were performed to assess HPA axis function. The Hamilton Depression Rating Scale (21-HAMD) was used weekly. ResultsA more pronounced down regulation of the HPA axis activity due to yoga could not be detected. The stepwise long term cortisol reduction was seen in both medication groups, irrespectively of yoga add-on treatment. In addition, cortisol improvers in week 1 of therapy (reduction in cortisol peak value within the DEX/CRH test) reached significant greater amelioration of depressive symptoms after 5 weeks. ConclusionsOur results suggest that antidepressant agents down regulate HPA axis function to a greater extent than additional Hatha yoga treatment. Moreover, an early reduction of HPA system hyperactivity after one week of pharmacological treatment seems to raise the possibility of a favorable treatment response.

Cost comparison of a commonly prescribed Antidepressant (Escitalopram)

DOI: http://dx.doi.org/10.3126/jpan.v1i1.9920 Journal of Psychiatrists' Association of Nepal Vol.1(1) 2011: 11-12

Examining relations between alpha power as well as anterior cingulate cortex-localized theta activity and response to single or dual antidepressant pharmacotherapies

Electrocortical indices may be useful in predicting antidepressant response. Greater pretreatment alpha power and high rostral anterior cingulate cortex (rACC) theta activity tend to index a favorable outcome. The predictive utility of alpha power asymmetry has been under-explored. Baseline alpha2 (10.5-13.0 Hz) power/asymmetry, rACC theta2 (6.0-8.0 Hz) activity and early (one week) changes in these measures were assessed in relation to antidepressant response by week 12 to three treatment regimens (escitalopram (ESC) + bupropion (BUP), ESC or BUP) in patients with major depressive disorder (N=51). No treatment differences in response existed at week 12. Overall, treatment responders exhibited high, and non-responders low, frontal baseline alpha2 power. Frontal alpha2 power weakly discriminated responders/non-responders overall while posterior alpha2 power and BA25-localized theta2 activity strongly discriminated ESC responders/non-responders. No associations with alpha2 asymmetry and response emerged. BUP responders exhibited high, and BUP non-responders low, baseline rACC theta2 activity. Greater early decreases in rACC theta2 activity existed in ESC+BUP non-responders versus ESC+BUP responders. BUP responders exhibited greater rACC theta2 activity decreases than ESC responders. These preliminary results indicate that baseline and early changes in alpha2 and rACC theta2 activity associate with response and have implications for tailoring antidepressant treatments.

A Marker for Treatment-Resistant Depression?

Most patients with major depression do not achieve remission with the first prescribed therapy. To try to find a biomarker for treatment resistance, investigators performed positron emission tomography (PET) and magnetic resonance imaging on 82 untreated patients with major depression and then randomized them to 12 weeks of treatment with either escitalopram (10–20 mg/day) or cognitive-behavioral therapy (CBT; 16 sessions). Of the …

Effects of escitalopram/quetiapine combination therapy versus escitalopram monotherapy on hypothalamic–pituitary–adrenal-axis activity in relation to antidepressant effectiveness

The hypothalamic–pituitary–adrenocortical (HPA) system is believed to play an important role in the pathophysiology of major depressive disorder. In this context, the atypical antipsychotic quetiapine (QUE) has been shown to inhibit HPA system activity in healthy subjects. In this study we investigated whether the putative inhibitory effects of QUE on HPA system activity may contribute to its antidepressant efficacy. We analyzed the effects of QUE as an augmentation to the selective serotonin reuptake inhibitor (SSRI) escitalopram (ESC) on HPA system activity in comparison to a monotherapy with ESC in relation to the antidepressant effectiveness. HPA axis activity (cortisol and ACTH) was measured by means of the dexamethasone/corticotropin-releasing hormone (DEX/CRH) test which was performed before (week 0) and during (week 1, week 5) antidepressant psychopharmacotherapy. The combination therapy, but not the ESC monotherapy showed significantly inhibiting effects on HPA system activity leading to stepwise down-regulation. ACTH concentrations were reduced in the ESC/QUE group during five weeks of treatment. The inhibitory effect of QUE maybe involved in its antidepressant effects as an augmentation strategy.

Effect of combination of ketanserin and escitalopram on behavioral anomalies after olfactory bulbectomy: prediction of quick onset of antidepressant action.

Objectives:Selective serotonin reuptake inhibitors (SSRIs) are the most commonly prescribed antidepressant drugs. The addition of low dose of 5-hydroxytryptamine type 2A enhances the therapeutic effect of SSRIs. The purpose of the present studies was to test the effects of combined treatment of a low dose of ketanserin (KET) and escitalopram (ESC) on behavioral anomalies occurring after olfactory bulbectomy (OBX).Materials and Methods:Chronic Depression was induced by OBX as shown in behavioral tests such as Open field, social interaction, and hyperemotionality tests. Acute and chronic treatment effect of KET, ESC, and combination was administered to the OBX rats.Results:Chronic (14 days) treatment with KET (1 mg/kg) or ESC (10 mg/kg) alleviated the behavioral anomalies of olfactory bulbectomized rats in modified open field exploration, social interaction, hyperemotionality. When KET treatment was combined with ESC, a short duration regimen (7 days) was sufficient to reverse the bulbectomy-induced anomalies.Conclusion:The combination therapy as a likely strategy to achieve an early-onset of antidepressant action.

EPA-1654 – Impact on cortisol and antidepressant efficacy of quetiapine and escitalopram in depression

In this study, the impact of quetiapine fumarate extended release (QXR) and escitalopram (ESC) on HPA axis activity was investigated in depressed patients in relationship to antidepressant efficacy. In a randomized, open-label 5-week trial 60 inpatients suffering from major depression (DSM-IV criteria) were treated for 5 weeks with either QXR (300 mg/day) or ESC (10 mg/day). The dexamethasone/CRH (DEX/CRH) test was performed before treatment, after 1, and after 5 weeks of treatment. Cortisol (COR) AUC values were used to assess HPA axis function. The Hamilton Depression Rating Scale was used weekly to estimate antidepressant efficacy. QXR and ESC showed comparable antidepressant effects but strongly differed in their impact on HPA axis activity. In the QXR group, a marked inhibition of COR AUC levels was observed which was most pronounced after one week of treatment but showed a partial re-increase after 5 weeks of treatment. In contrast, ESC transiently stimulated COR AUC values (week 1) whereas COR AUC levels at week 0 and week 5 were comparable. COR improvement at week 1 (defined as COR peak value reduction between DEX/CRH test 1 and 2) was significantly associated with better clinical outcome. Apparently, different effects on HPA axis activity reflect distinct pharmacoendocrinological properties of psychotropic drugs.

Escitalopram best choice for MDD in Italy

Escitalopram best choice for MDD in Italy

High impact child abuse may predict risk of elevated suicidality during antidepressant initiation

Concerns have emerged that initiation of an antidepressant can lead to or exacerbate suicidality. If those more at risk could be identified prior to treatment, treatment risk benefit analysis and patient risk management could be assisted. This study investigated the role of child abuse and ongoing emotional impact from abuse on the risk of suicidality during the first week of treatment with an antidepressant. The patient sample for this study was drawn from one site of a larger pharmacogenetic study. The hypothesis was that subjects with high impact child abuse would have greater elevation of suicidality during the first week of antidepressant treatment. Fifty-one subjects were initiated on either venlafaxine (VEN) or escitalopram (ESC) for major depressive disorder (MDD) and had pre-treatment suicidality assayed with the reasons for living scale (RFLS), which was repeated after one week of treatment. Several clinical, demographic and genotype variables were controlled for. The 15-item Impact of Event Scale (IES-15) was administered to subjects reporting abuse to dichotomise the abuse group into low and high (IES-15 ≥ 26) impact groups for sub-analysis as per the scales validated rating guidelines. Subjects reporting no child abuse exposure were less likely to have increased suicidality during the first week of antidepressant treatment (7.6%) compared to subjects with low impact abuse (38.5%, p = 0.041) and high impact abuse (58.3%, p = 0.009). Only high impact abuse predicted increased suicidality after adjustment for potential confounders such as depression severity (OR = 31.5, 95% CI = 1.3 to 748.7, p = 0.03). If these findings are replicated in larger samples, child abuse history could become an important element of assessing risk benefit balance when initiating antidepressants and may help guide the level of patient review needed during antidepressant initiation.

The safety profile of escitalopram in pregnancy and breastfeeding

Escitalopram (ESC) is considered one of the most effective selective serotonin reuptake inhibitors (SSRI) for the treatment of major depression disorder. However, little is known on its potential risk of inducing major malformations (MM) and/or perinatal complications (PC). Aim of the present study is to provide a review of the available literature on the safety profile of ESC during pregnancy and breastfeeding and to compare data with the maternal and neonatal outcomes of 8 cases of the DEGRA Center. MEDLINE and PubMed databases were searched for English language articles by using the following keywords: "escitalopram", "selective serotonin reuptake inhibitors", "major malformations", "perinatal complications", "pregnancy", "breastfeeding". We also reported 8 cases of women treated with ESC during their pregnancy and breastfeeding at the Clinic of Affective Disorders in Pregnancy and Postpartum of the United Hospital of Ancona (DEGRA Center). Although some cases of MM have been reported in the literature after maternal exposure to ESC during early pregnancy, the rate of MM is substantially in the range of those reported in unexposed women. ESC exposure seems to be significantly associated with some PC such as lower rates of live births and higher rates of newborns with low birth weight. On the contrary, no short-term adverse effects in newborns were reported in the 5 studies evaluating the safety of ESC during breastfeeding. Data coming from DEGRA Center are consistent with the literature: all pregnancy were full term, all newborns were healthy and obtained normal APGAR score; no MM or miscarriage were reported. Only one case of mild withdrawal syndrome was reported in a newborn who was also exposed to benzodiazepines and paroxetine late in pregnancy. Two infants exposed to ESC also during the lactation did not reported any adverse effects at short-term. Data coming from published studies and from our cases seem to support the notion that ESC might be considered safe during pregnancy and breastfeeding, particularly as far as MM is concerned. As well as other SSRI it could be associated with an increased risk of PC. Nevertheless, given the few cases here analysed and the paucity of the studies so far published, no definitive conclusions should be drawn.

Evaluation of Escitalopram, Sertraline, and Methylphenidate in the Immature Rat Uterotrophic Assay

Psychotropics are among the most prescribed medications. There are indications in the literature that fluoxetine (FLX; selective serotonin reuptake inhibitor [SSRI] antidepressant) and methylphenidate (MPH) could have a hormonal mode of action. This study was designed to evaluate the immature rat uterotrophic assay Substitute by (1) if sertraline (SER) and escitalopram (ESC) 2 other SSRI antidepressants would share the estrogenicity described for FLX and (2) MPH for estrogenicity and antiestrogenicity. The 18-day-old Wistar rats with were divided into olive oil, estradiol (0.3 mg/kg), estradiol + tamoxifen (10 mg/kg), SER (5, 15, or 45 mg/kg), ESC (2, 6, or 18 mg/kg), MPH (2.5 or 5 mg/kg), and estradiol + MPH groups. As expected, estradiol increased the weight of uterus, and this effect was counterbalanced by concomitant treatment with tamoxifen. The SER, ESC, and MPH had no effect on the uterus weight. The results suggest that ESC and SER do not share the estrogenicity described for FLX and that MPH does not disrupt estrogenic signaling.

Impact on cortisol and antidepressant efficacy of quetiapine and escitalopram in depression

In this study, the impact of quetiapine fumarate extended release (QXR) and escitalopram (ESC) on HPA axis activity was investigated in depressed patients in relationship to antidepressant efficacy. In a randomized, open-label 5-week trial 60 inpatients suffering from major depression (DSM-IV criteria) were treated for 5 weeks with either QXR (300 mg/day) or ESC (10mg/day). The dexamethasone/CRH (DEX/CRH) test was performed before treatment, after 1, and after 5 weeks of treatment. Cortisol (COR) AUC values were used to assess HPA axis function. The Hamilton Depression Rating Scale was used weekly to estimate antidepressant efficacy. QXR and ESC showed comparable antidepressant effects but strongly differed in their impact on HPA axis activity. In the QXR group, a marked inhibition of COR AUC levels was observed which was most pronounced after one week of treatment but showed a partial re-increase after 5 weeks of treatment. In contrast, ESC transiently stimulated COR AUC values (week 1) whereas COR AUC levels at week 0 and week 5 were comparable. COR improvement at week 1 (defined as COR peak value reduction between DEX/CRH test 1 and 2) was significantly associated with better clinical outcome. Apparently, different effects on HPA axis activity reflect distinct pharmacoendocrinological properties of psychotropic drugs.

Pharmacogenetic polymorphisms and response to escitalopram and venlafaxine over 8 weeks in major depression

The objective of this study is to investigate the influence of the 5-HTTLPR (serotonin transporter-linked promoter region), cytochrome P450 2C19, and cytochrome P450 2D6 polymorphisms on escitalopram (ESC) and venlafaxine (VEN) responses in major depressive disorder. A prospective multi-site study of 106 patients (Caucasian and Han Chinese ethnicities) with major depressive disorder treated with either ESC or VEN was conducted. The 17-item Hamilton Depression scale (HDRS), Clinical Global Impression Scale, and an adverse events scale (UKU) were assessed over 8 weeks, blind to genotype. At the 8-week end point, a significant HDRS reduction for both ESC and VEN occurred (p < 0.0001). The 5-HTTLPR l/l genotype was associated with significantly greater score reductions on the HDRS compared with s/s carriers (p = 0.016) among Caucasian subjects receiving ESC (n = 47). Response rates were significantly higher for l/l (92%) compared with l/s (61%) and s/s (46%) variants (p = 0.042). For every l allele a participant carried, there was a 3.33 (95% confidence interval 1.25, 8.84; p = 0.02) times greater odds of ESC response. No significant associations between any of the genotypes and adverse effects were found. Ethnicity may have differential effects on the 5-HTTLPR genotype-efficacy relationship. Results suggest that l/l allele for 5-HTTLPR is associated with a robust treatment response to ESC in Caucasian subjects only.

Effects of escitalopram on the expression of glial cell line-derived neurotrophic factor and apoptosis related factors in hippocampus of depression model rats

Objective To explore the effects and mechanisms of escitalopram on the expression of glial cell line-derived neurotrophic factor(GDNF) in hippocampus of depression model rats. Methods 40 male SD rats were randomly divided into four groups: control group(group A), control+ escitalopram group (group B), depressive group(group C), and depressive+ escitalopram group(group D). Chronic mild unpredicted stress(CUMS)with solitary condition was taken to establish rat depression model. And the group B and D were treated with intragastric admistration of escitalopram(10 mg·kg-1·d-1), the group A and C with sodium chloride.The open-field test and sucrose consumption were used to evaluate the depression behaviors of rats. The apoptotic hippocampal cells were detected by TUNEL.And the expression of GDNF, Bax, Bcl-2 and Caspase3 mRNA were detected by real-time RT-PCR. Results ① Compared with group A(12.0±1.83), the number of apoptotic cells in hippocampus was significantly increased in group C(19.3±1.77)(P 0.05). Compared with group C, the group D(12.7±1.77) had a significant reduction in the number of apoptotic cells (P<0.01). ②Compared with group A, GDNF and Bcl-2 mRNA expression was decreased (P<0.01), but Bax and Caspase3 mRNA expression was both increased significantly in group C(P<0.01); while in group D, GDNF and Bcl-2 mRNA expression was higher (P<0.01), but Bax and Caspase3 mRNA expression was lower than that in group C(P<0.01). Conclusion Escitalopram can improve depressive behaviors and reduce hippocampal apoptosis, which maybe associate with increasing GDNF protein and mRNA expression, and promoting the regeneration of neurons, up-regulating of mRNA Bcl-2 expression, and down-regulating of mRNA Bax and Caspase3 expression.Finally it may prevent the neuronal apoptosis in hippocampal and play the role of cerebral protection. Key words: Escitalopram; Depression; Hippocampus; Glial cell line-derived neurotrophic factor; Apoptosis

Clinical effects of escitalopram treatment combined with psychological interventions during peri-parturition period for patients with postpartum depression

Objective To explore the clinical effects of escitalopram combined with psychological interventions during peri-parturition period for patients with postpartum depression. Methods From July to December in 2012, totally 493 pregnant women were performed psychological interventions during peri-parturition period, and 34 cases of them who suffered from postpartum depression were treated with escitalopram 10mg daily combined with systemic psychotherapy as the study group. From January to June in 2012, totally 367 pregnant women were not performed psychological interventions during peri-parturition period, and 32 cases who suffered from postpartum depression were treated with escitalopram 10 mg daily and only with support psychotherapy as the control group. Both groups were observed for 8 weeks. The Hamilton rating scale (HAMD) and Clinical Global Impression-severity of illness (CGI-SI) were tested before treatment and after 1, 2, 4 and 8 weeks of treatment to evaluate the efficacy.The data were compared. Results The incidence of postpartum depression was 7.7% in the study group which was significantly lower than that in the control (11.7%, χ2=3.96, P 0.05). Conclusion Psychological interventions during peri-parturition period and escitalopram treatment combined with systemic psychotherapy in depression stage had better effects on preventing and curing postpartum depression. Key words: Escitalopram; Peri-parturition period; Psychotherapy; Postpartum depression

Development of New Sensors for Determination of Escitalopram Oxalate in Dosage Forms and Biological Fluids

Development of New Sensors for Determination of Escitalopram Oxalate in Dosage Forms and Biological Fluids

Prevention of Depression With Escitalopram in Patients Undergoing Treatment for Head and Neck Cancer&lt;subtitle&gt;Randomized, Double-blind, Placebo-Controlled Clinical Trial&lt;/subtitle&gt;&lt;alt-title&gt;Escitalopram for Depression Prevention&lt;/alt-title&gt;

Major depressive disorder develops in up to half the patients undergoing treatment for head and neck cancer, resulting in significant morbidity; therefore, preventing depression during cancer treatment may be of great benefit. To determine whether prophylactic use of the antidepressant escitalopram oxalate would decrease the incidence of depression in patients receiving primary therapy for head and neck cancer. A randomized, double-blind, placebo-controlled trial of escitalopram vs placebo was conducted in a group of nondepressed patients diagnosed as having head and neck cancer who were about to enter cancer treatment. Patients were stratified by sex, site, stage (early vs advanced), and primary modality of treatment (radiation vs surgery). The primary outcome measure was the number of participants who developed moderate or greater depression (scores on the Quick Inventory of Depressive Symptomology-Self Rated of ≥11). From January 6, 2008, to December 28, 2011, 148 patients were randomized. Significantly fewer patients receiving escitalopram developed depression (24.6% in the placebo group vs 10.0% in the escitalopram group; stratified log-rank test, P = .04). A Cox proportional hazards regression model compared the 2 treatment groups after controlling for age, baseline smoking status, and stratification variables. The hazard ratio of 0.37 (95% CI, 0.14-0.96) demonstrated an advantage of escitalopram (P = .04). Patients undergoing radiotherapy as the initial modality were significantly more likely to develop depression than those undergoing surgery (radiotherapy compared with surgery group; hazard ratio, 3.6; 95% CI, 1.38-9.40; P = .009). Patients in the escitalopram group who completed the study and were not depressed rated their overall quality of life as significantly better for 3 consecutive months after cessation of drug use. In nondepressed patients undergoing treatment for head and neck cancer, prophylactic escitalopram reduced the risk of developing depression by more than 50%. In nondepressed patients who completed the trial, quality of life was also significantly better for 3 consecutive months after cessation of drug use in the escitalopram group. These findings have important implications for the treatment of patients with head and neck cancer. clinicaltrials.gov Identifier: NCT00536172.

Adding CBT to SSRIs for Older Patients with Generalized Anxiety Disorder

Generalized anxiety disorder (GAD), seen in up to 7.3% of older adults, is generally chronic and is associated with risk for cardiovascular and cognitive impairment and higher healthcare utilization. Pathological worry may be even greater in older than in younger patients. This multisite, three-phase study involved 73 patients at least age 60 with GAD who received the selective serotonin reuptake inhibitor (SSRI) escitalopram (10–20 mg/day) for the 12-week …