DOI: http://dx.doi.org/10.18203/2319-2003.ijbcp20180091

A comparative study on efficacy of amitriptyline and escitalopram in the treatment of depression

Sushant Aryal, Kajal Chakrabarti, Mayuri Gupta

Abstract


Background: Several generations of antidepressant medication which act by distinct pharmacological mechanisms have been introduced for the treatment of depression; tricyclic antidepressants (TCAs) were first line of treatment for many years. However, over the last decade, selective serotonin reuptake inhibitors (SSRIs) have displaced TCAs, mainly because of better side effect profile. There are no references in literature on comparison of efficacy of TCAs and SSRIs in Nepalese population. This study attempted to compare the efficacy of amitriptyline, a reference standard TCA with escitalopram, a newer SSRI in Nepalese population.

Methods: An open level, randomised, prospective study was conducted for one year duration. Eighty outpatients suffering from major depression who met inclusion and exclusion criteria were randomly assigned to either amitriptyline or escitalopram group for four week study. Seventy one patients (amitriptyline N: 36, escitalopram N: 35) completed the study. Hamilton Depression Rating Scale (HDRS) was used to measure the antidepressant effect. Antidepressant efficacy was evaluated on reduction of HDRS score before and after therapy (End of four weeks).

Results: In amitriptyline group, mean percentage reduction in HDRS score was 58.29% (13.5 points), while in escitalopram group was 60.78% (14.03 points). Both the drugs significantly improved the HDRS score at the end of the study (p<0.05). On intergroup comparison, antidepressant efficacy of amitriptyline and escitalopram did not differ significantly from each other (p>0.05).

Conclusions: This study suggests that escitalopram is effective in the treatment of depression and its efficacy appears to be comparable to amitriptyline at the end of four weeks.


Keywords


Amitriptyline, Comparative, Escitalopram, Efficacy

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References


Kessler RC, Bromet EJ. The epidemiology of depression across cultures. Annu Rev Public Health. 2013;34:119-38.

Cassano P, Fava M. Depression and public health: an overview. J Psychosom Res. 2002;53(4):849-57.

Artigas F, Nutt DJ, Shelton R. Mechanism of action of antidepressants. Psychopharmacol Bull. 2002;36(2):123-32.

Palazidou E. Development of new antidepressants. Adv Psychiatr Treat. 1997;3:46-51.

Tatsumi M, Groshan K, Blakely RD, Richelson E. Pharmacological profile of antidepressants and related compounds at human monoamine transporters. Eur J Pharmacol. 1997;340:249-58.

Barbui C, Hotopf M. Amitriptyline vs the rest: still the leading antidepressant after 40 years of randomised controlled trials. Brit J Psychiat. 2001;178(2):129-44.

National Institute for Health and Clinical Excellence. Depression: the treatment and management of depression in adults. 2nd Edition. Great Britain: RCPsych Publications; 2010:330.

Owens MJ, Knight DL, Nemeroff CB. Second-generation SSRIs: human monoamine transporter binding profile of escitalopram and R-fluoxetine. Biol Psychiat. 2001;50:345-50.

Jain R. Single-action versus dual-action antidepressants. Prim Care Companion J Clin Psychiatry. 2004;6(1):7-11.

Kennedy SH, Andersen HF, Lam RW. Efficacy of escitalopram in the treatment of major depressive disorder compared with conventional selective serotonin reuptake inhibitors and venlaxafine XR: a meta-analysis. J Psychiatry Neurosci. 2006;31(2):122-31.

Culpepper L. Escitalopram. A New SSRI for the Treatment of Depression in Primary Care. Prim Care Companion J Clin Psychiatry. 2002;4(6):209-14.

Arroll B, Macgillivray S, Ogston S, Reid I, Sullivan F, Williams B, et al. Efficacy and tolerability of tricyclic antidepressants and SSRIs compared with placebo for treatment of depression in primary care: a meta-analysis. Ann Fam Med. 2005;3(5):449-56.

Von Wolff A, Holzel LP, Westphal A, Harter M, Kriston L. Selective serotonin reuptake inhibitors and tricyclic antidepressants in the acute treatment of chronic depression and dysthymia: a systematic review and meta-analysis. J Affect Disord. 2012;144(1-2):7-15.

Anderson IM, Tomerson BM. The efficacy of selective serotonin re-uptake inhibitors in depression: a meta-analysis of studies against tricyclic antidepressants. J Psychopharmacol. 1994;8:238-49.

Nierenberg AA. The treatment of severe depression: is there an efficacy gap between SSRI and TCA antidepressant generations? J Clin Psychiat. 1994;55:55-9.

Hirschfeld RM. Efficacy of SSRIs and newer antidepressants in severe depression: comparison with TCAs. J Clin Psychiat. 1999;60(5):326-35.

Olver JS, Burrows GD, Norman TR. Third-generation antidepressants: do they offer advantages over the SSRIs? CNS Drugs. 2001;15:941-54.

Barbey JT, Roose SP. SSRI safety in overdose. J Clin Psychiat. 1998;59(15):42-8.

Blay SL, Andreoli SB, Fillenbaum GG, Gastal FL. Depression morbidity in later life: prevalence and correlates in a developing country. Am J Geriat Psychiat. 2007;15:790-9.

Patten SB, Wang JL, Williams JV, Currie S, Beck CA, Maxwell CJ. Descriptive epidemiology of major depression in Canada. Can J Psychiat. 2006;51:84-90.

Hasin DS, Goodwin RD, Stinson FS, Grant BF. Epidemiology of major depressive disorder: results from the national epidemiologic survey on alcoholism and related conditions. Arch Gen Psychiat. 2005;62:1097-106.

Kolchakova PY, Akabaliev VH. A study of the effect of age on depressivity in Bulgarian urban population. Folia Med. 2003;45:11-5.

Aluoja A, Leinsalu M, Shlik J, Vasar V, Luuk K. Symptoms of depression in the Estonian population: prevalence, sociodemographic correlates and social adjustment. J Affect Disord. 2004;78:27-35.