To compare the tolerability and efficacy of escitalopram and duloxetine in the treatment of patients with major depressive disorder over 8 weeks.

Data from two randomised, multi-centre, double blind studies in specialist1 or psychiatric and general practice settings were pooled and analysed for all patients and for severely depressed patients (baseline MADRS at least 30). The primary efficacy measure in both studies was the MADRS total score.

Patients were randomised to either escitalopram (10-20mg/day) (n=280) or duloxetine (60mg/day) (n=284). Escitalopram was statistically significantly superior to duloxetine with respect to mean change from baseline in MADRS total score at Weeks 1, 2, 4, and 8 (LOCF). The mean treatment difference at Week 8 was 2.6 points (p<0.01). For severely depressed patients, a mean treatment difference at Week 8 of 3.7 points (p<0.01) was seen. Response to treatment at Week 8 was statistically significantly greater for patients treated with escitalopram, as was remission when defined as MADRS<=10 or 12. The percentage of escitalopram-treated patients that withdrew (12.9%, n=36) was significantly (p<0.001) less than in the duloxetine group (24.3%, n=69). Significantly fewer (p<0.001) escitalopram-treated patients withdrew due to adverse events (4.6%, n=13) than from the duloxetine group (12.7%, n=36).

Escitalopram showed advantages in efficacy and tolerability compared to duloxetine in the acute treatment of patients with major depression. There were additional benefits for escitalopram-treated patients with severe depression.