Posted by moxy1000 on September 10, 2002, at 18:45:51
In reply to Re: Fewer s/e with Lexapro - where's the evidence? » moxy1000, posted by dr. dave on September 10, 2002, at 4:42:08
Overall, Dr. Dave, after doing some extensive research today, I think you are absolutely right in saying that presently that are is a lack of "overwelming" evidence. In all three studies I've found, involving both Celexa and Lexapro, only one presented a table of treatment emergent side effects comparing the two active agents. (This was the table in Clinical Psychiatry, April 2002, included in the study presented by Dr. Burke.) It was a double blind, placebo controlled trial, but I've left out the placebo numbers for space sake. (The placebo rates, as we'd expect, were lower then the two active drugs.)
The table looks like this:
Nausea Celexa 40mg 22% Lexapro 10mg 21%
Diarrhea Celexa 40mg 11% Lexapro 10mg 10%
Insomnia Celexa 40mg 11% Lexapro 10mg 10%
Dry Mouth Celexa 40mg 10% Lexapro 10mg 10%
Ejaculation Dis. Cx 40mg 4% Lexapro 10mg 9%The only major difference in tolerability in the Burke study, was in the drop out rates.
2.5% dropped out on placebo due to side effects
4.2% dropped out on Lex 10mg due to side effects
8.8% dropped out on Cel 40mg due to side effects(Perhaps the rate of side effect occurance potentially the same for both Lexapro and Celexa, but the severity of those side effects differ? That could explain the higher Celexa drop out rate.)
At any rate, I think the biggest difference between Celexa and Lexapro in this study was in the area of efficacy. On every testing instrument used (HAM-D, MADRS, CGI-I) Lexapro at 10 mg was at least as effective as Celexa 40mg. (And how often is it possible to jump into Celexa therapy at 40mg? Starting dose is usually 20mg.) I think that's where the earlier onset of improvement in depressive symptoms comes in for Lexapro.
I think it's standard for all SSRI's to take 4-6 weeks for improvement in depressive symptoms (at least that is what is stated in the package inserts of all available treatments.) Sure, not every patient is the same, some probably respond to therapy sooner (I took wellbutrin and felt it kick in after a couple weeks), some may never respond at all, some may feel better after a month or longer. But, If Lexapro can offer the majority of patients, as it appears that it can from all efficacy studies available, earlier relief at 1-2 weeks, would that not be an improvement over not only Celexa, but some other AD's as well?
Let's say for the sake of argument that the side effect profile is essentially the same. Wouldn't having the ability to offer depressed patients relief sooner be an advantage? After all, from all indications, both Lex and Celexa look like they are pretty well tolerated to begin with.
I hope this info helped.
poster:moxy1000
thread:109458
URL: http://www.dr-bob.org/babble/20020906/msgs/119493.html