艾司西酞普兰和文拉法辛缓释剂治疗抑郁症的疗效及耐受性比较

目的比较艾司西酞普兰和文拉法辛缓释剂治疗抑郁症患者的疗效、耐受性和起效时间。方法选择住院及门诊中重度抑郁症患者130例,进行为期8周的艾司西酞普兰（10～20mg／d,n=65）和文拉法辛缓释剂（75～150mg／d,n：65）治疗,采用蒙格马利一阿斯伯格抑郁评定量表（MADRS）进行疗效评定。结果第8周时,应用MADRS评分,两组疗效相似;艾司西酞普兰组患者获得持续缓解的速度明显快于文拉法辛组;文拉法辛组出现恶心、便秘和多汗较多（P〈0．05）,停药患者较多（P〈0．01）。结论艾司西酞普兰和文拉法辛缓释荆治疗抑郁症患者疗效相似,而艾司西酞普兰耐受性和起效速度更佳。     

国产艾司西酞普兰与文拉法辛缓释剂治疗抑郁症的对照研究

目的探讨国产艾司西酞普兰治疗抑郁症的临床疗效及安全性。方法将68例符合入组条件的抑郁症患者随机分为研究组和对照组,每组34例,分别采用国产艾司西酞普兰和文拉法辛缓释剂治疗,疗程6周,以HAMD抑郁量表评定疗效,TESS量表评定不良反应。结果研究组总有效率为88.2%,对照组总有效率为85.3%,两组差异无统计学意义（P〉0.05）,但国产艾司西酞普兰在治疗1周后HAMD评分即发生明显改变,文拉法辛缓释剂治疗组在2周后HAMD评分才有明显改变,副作用两组发生率均较低。结论艾司西酞普兰与文拉法辛均是安全有效的抗抑郁药物,但艾司西酞普兰起效更快。     

艾司西酞普兰与文拉法辛缓释剂治疗广泛性焦虑障碍的对照研究

目的:观察艾司西酞普兰与文拉法辛缓释剂治疗广泛性焦虑障碍的疗效和安全性。方法:将74例符合《国际疾病与相关健康问题统计分类(ICD)第10版》(ICD-10)广泛性焦虑障碍的患者随机分成艾司西酞普兰组(n=38)和文拉法辛缓释剂组(n=36),治疗持续8周,用汉密尔顿焦虑量表(HAMA)评定患者焦虑症状及疗效,用汉密尔顿抑郁量表(HAMD)评定患者的抑郁症状,同时用不良反应量表(TESS)和实验室检查评估治疗安全性。结果:治疗1周末两组HAMA评分开始明显下降(P<0.01),第1、2、4周末艾司西酞普兰组HAMA减分率明显高于文拉法辛缓释剂组(P<0.05),但是第8周末两组的减分率无统计学差异(P>0.05)。8周末两组的治愈率分别为60.5%和66.7%,有效率分别为78.9%和86.1%,文拉法辛缓释剂组显著高于艾司西酞普兰组(P<0.01)。8周末两组HAMD评分较治疗前也均有明显下降(P<0.01)。两组不良反应差异无统计学意义(P>0.05)。结论:文拉法辛缓释剂治疗广泛性焦虑总体疗效优于艾司西酞普兰,但是艾司西酞普兰起效快于文拉法辛缓释剂,两者安全性无明显差异。     

艾司西酞普兰治疗老年抑郁症的临床疗效

目的 评价艾司西酞普兰治疗老年抑郁症的疗效和安全性.方法 将90例老年抑郁症患者随机分为3组(每组均30例):艾司西酞普兰组、舍曲林组和文拉法辛组,分别给予艾司西酞普兰、舍曲林和文拉法辛治疗,疗程8周,分别在治疗前和治疗后1,2,4,6,8周,用汉密尔顿抑郁量表(HAMD)评定疗效,用副反应量表(TESS)评定药物不良反应.结果 治疗后,3组HAMD评分均较治疗前明显下降,依次排序为艾司西酞普兰、文拉法辛和舍曲林(P＜0.01).艾司西酞普兰和舍曲林组药物不良反应均较少,2组在第1,6周末差异均无统计学意义(P＞0.05);但艾司西酞普兰较文拉法辛具有更好的耐受性,各种不良反应发生率均明显低于文拉法辛组(P＜0.01).结论 艾司西酞普兰治疗老年抑郁症疗效确切、依从性好,且起效快、不良反应较少.     

艾司西酞普兰治疗重度抑郁症门诊与住院疗效比较

目的 了解艾司西酞普兰治疗门诊重度抑郁症患者的疗效与安全性.方法 将随机纳入的重度抑郁症患者80例分成2组,试验组40例,在门诊应用艾司西酞普兰治疗,对照组40例,在住院部应用艾司西酞普兰治疗.比较两组治疗前,治疗后7、14、21、28和56d的汉密尔顿抑郁量表(HAMD)评分值.结果 试验组有效率77.5%,对照组有效率80.0%.两组均不良反应少.结论 艾司西酞普兰可以应用于门诊重度抑郁症患者,替代住院治疗.     

艾司西酞普兰与文拉法辛治疗老年抑郁障碍的疗效比较

目的比较艾司西酞普兰与文拉法辛对老年抑郁障碍患者的临床疗效及不良反应。方法将68例符合《中国精神障碍分类与诊断标准》(第3版)抑郁发作诊断标准的老年抑郁障碍患者随机分为2组,分别给予艾司西酞普兰或文拉法辛治疗8周。采用汉密尔顿抑郁量表(HAMD 17)、临床疗效总评量表严重性项目(CGI SI)和治疗时出现的症状量表(TESS)评定疗效和不良反应。结果治疗8周后艾司西酞普兰组有效22例(64.7%),起效7例(20.6%),有效率85.3%,不良反应发生率35.3%;文拉法辛组有效24例(70.6%),起效6例(17.6%),有效率88.2%,不良反应发生率41.2%。2组有效率和不良反应发生率之间差异无统计学意义(P>0.05)。结论艾司西酞普兰与文拉法辛治疗老年抑郁障碍均具有疗效确切,起效较快,不良反应少等优点,适合老年患者使用。     

艾司西酞普兰与文拉法辛治疗首发抑郁症疗效分析

目的 比较艾司西酞普兰和文拉法辛治疗抑郁症患者的疗效及安全性.方法 将60例首发抑郁症患者随机分为艾司西酞普兰组(n=30例)和文拉法辛组(n=30例),治疗时间为8周.以汉密米尔顿抑郁量表(HAMD)与治疗中出现的症状量表(TESS)评定疗效和不良反应.结果 治疗后两组均有显著的疗效.两组疗效比较差异无统计学意义.结论 艾司西酞普兰和文拉法辛均可作为治疗抑郁症的首选药物.     

艾司西酞普兰治疗抑郁症的疗效观察

目的探讨艾司西酞普兰治疗抑郁症的疗效。方法将笔者所在医院收治的84例抑郁症患者随机分为两组,治疗组用艾司西酞普兰治疗,对照组用文拉法辛治疗。评价两组的疗效差异。结果观察组和对照组的有效率分别为97.6%、95.2%,两组治疗后各时段的HAMD总分均显著低于治疗前(P<0.05),观察组治疗1周末的HAMD总分显著低于对照组(P<0.05)。结论艾司西酞普兰治疗抑郁症疗效较好,起效快,不良反应小,安全性高。     

文拉法辛与艾司西酞普兰治疗抑郁症的循证药物经济学评价

目的:系统评价文拉法辛与艾司西酞普兰治疗抑郁症的药物经济学效果。方法:以"文拉法辛""艾司西酞普兰""抑郁症""抑郁发作""抗抑郁"等作为关键词,计算机检索中国期刊全文数据库(CNKI)、维普中文期刊全文数据库(VIP)、万方医学数据库,检索时间为创库日期至2015年12月,筛选符合纳排标准的文拉法辛与艾司西酞普兰治疗抑郁症的相关文献。统计两组方案治疗抑郁症的痊愈率和汉密尔顿抑郁量表(HAMD)评分,并采用药物经济学中成本-效果分析法对其进行分析。结果:两组方案痊愈率和HAMD评分比较,差异均无统计学意义(P>0.05),故采用最小成本法进行分析。文拉法辛与艾司西酞普兰治疗抑郁症的成本分别为772.03、935.77元。结论:文拉法辛与艾司西酞普兰治疗抑郁症的疗效相当,但文拉法辛方案更为经济。     

西酞普兰与文拉法辛治疗抑郁症的临床对照研究

目的:比较西酞普兰与文拉法辛治疗抑郁症的效果及不良反应.方法:收集符合CCMD-3抑郁症诊断标准的门诊患者57名,随机分为西酞普兰组(n=29)和文拉法辛组(n=28).西酞普兰组服用剂量为每日20～40 mg,文拉法辛组服用剂量为每日50～300 mg,观察期限为7周.采用HAMD、SDS和临床4级疗效评定法同时进行疗效评定,采用TESS不良反应量表评定不良反应.结果:治疗后7周末评定结果显示,两组SDS总分、HAMD总分及7个因子分均比治疗前有显著下降(P＜0.01).两组的有效率相似,分别为93%(西酞普兰组)和89%(文拉法辛组)两者比较,无显著差异(P＞0.05).两组的不良反应格局大体相似,程度轻微,患者均能耐受.结论:西酞普兰和文拉法辛治疗抗抑郁症的作用相似,不良反应轻微,临床运用安全.     

Duloxetine: a review of its use in the treatment of major depressive disorder

Duloxetine (Cymbalta) is an orally administered, selective serotonin and noradrenaline reuptake inhibitor (SNRI) that has been approved for the treatment of major depressive disorder (MDD).Based on a considerable body of evidence, duloxetine at dosages ranging from 40 to 120 mg/day was effective in the short- and long-term treatment of MDD. Significant improvements versus placebo in core emotional symptoms as well as painful physical symptoms associated with depression, were seen in most, but not all, appropriately designed studies; results of meta-analyses suggested that improvements in these efficacy measures were apparent after 1-2 weeks' treatment with the highest recommended dosage of 60 mg once daily. Short-term (< or =15 weeks) administration of duloxetine at fixed or flexible dosages between 60 and 120 mg/day was noninferior to paroxetine 20 mg once daily, noninferior or inferior to escitalopram 10-20mg once daily, and had a similar global benefit-risk (GBR) profile to that of venlafaxine extended-release (XR) 150-225 mg/day in the treatment of MDD. Longer-term (6-8 months) treatment with duloxetine was similar in efficacy to paroxetine and escitalopram. Duloxetine is generally well tolerated, although it may be appropriate to avoid initiating treatment with the 60 mg/day dosage, as this has been associated with a higher discontinuation rate due to adverse events in some (but not all) comparative studies with escitalopram and venlafaxine XR.Definitive comparisons are awaited, although duloxetine seemingly provides a useful alternative to SSRIs and other SNRIs for the treatment of MDD. It also appears to be an attractive option for MDD patients presenting with painful physical symptoms.     

Eight-week, placebo-controlled, double-blind comparison of the antidepressant efficacy and tolerability of bupropion XR and venlafaxine XR

The efficacy, safety and tolerability of bupropion XR and venlafaxine XR was assessed and compared with placebo in adult outpatients with major depressive disorder (MDD). Adults meeting DSM-IV criteria for MDD with a minimum Hamilton Depression Rating Scale (HAMD) 17-Item total score of > or =18 were randomized to eight weeks of double-blind treatment with either bupropion XR (150 mg/day), venlafaxine XR (75 mg/day) or placebo. At the end of the fourth week of treatment, a dosage increase to bupropion XR 300 mg/day or venlafaxine XR 150 mg/day was allowed if, in the opinion of the investigator, response was inadequate. The primary efficacy endpoint was mean change from baseline at week 8 in the Montgomery-Asberg Depression Rating Scale (MADRS) total score last observation carried forward (LOCF). Mean changes from baseline at week 8 (LOCF) in MADRS total score were statistically significant for bupropion XR and venlafaxine XR patients compared to the placebo group: -16.0 for bupropion XR (P = 0.006 vs placebo), -17.1 for venlafaxine XR (P < 0.001 vs placebo) and -13.5 for placebo. Secondary outcomes (including CGI-S, HAM-A, MEI, Q-LES-Q-SF, responder and remitter analyses) also improved significantly for both active treatment groups compared with placebo. The most frequently reported adverse events were dry mouth and insomnia for bupropion XR, and nausea, hyperhidrosis, fatigue, and insomnia for venlafaxine XR. In this double-blind, placebo-controlled trial, bupropion XR at doses up to 300 mg/day and venlafaxine XR at doses up to 150 mg/day demonstrated comparable antidepressant efficacy.     

Escitalopram versus venlafaxine XR in the treatment of depression

This article reanalyses and reviews data from the two published randomized clinical trials comparing escitalopram and venlafaxine XR in the treatment of patients with major depressive disorder. The aim was to further compare the efficacy and tolerability of escitalopram and venlafaxine XR and to assess the impact of the two treatments on the patient's quality of life, as well as the benefit/risk of treatment. A total of 243 escitalopram-treated patients and 240 venlafaxine XR-treated patients were included in this analysis. Comparable treatment efficacy was achieved with respect to the prospectively defined primary efficacy endpoint (mean change from baseline in Montgomery Asberg Depression Rating Scale (MADRS) total score at week 8). An analysis of the outcome at the end of study by baseline severity showed that the treatment difference became greater the more severely depressed the patients were at baseline. At the highest permitted doses, in the subgroup of patients who were severely depressed (baseline MADRS > or =30), patients treated with escitalopram had a statistically significantly greater improvement (P<0.05) in mean MADRS total scores than patients treated with venlafaxine XR at endpoint. For these patients, treatment with 20 mg/day escitalopram resulted in a statistically significantly (P<0.05) higher remission rate at week 8 (47%) than treatment with venlafaxine XR (29%). This difference was confirmed by the analysis of the pooled data, which showed that patients in the escitalopram group had a significantly (P<0.05) higher mean number of depression-free days (30.4 days) than those in the venlafaxine XR group (26.2 days) over the 8-week period. The relative benefit of escitalopram versus venlafaxine XR was 1.46, indicating that a patient was more likely to benefit from treatment with escitalopram. The proportions of patients who withdrew owing to adverse events were 7.5% in the escitalopram group and 11.2% in the venlafaxine XR group. The mean number of discontinuation emergent signs and symptoms in the venlafaxine XR group (mean: 5.0) was significantly (P<0.001) higher than for the escitalopram group (mean: 2.4).     

A double-blind comparison between bupropion XL and venlafaxine XR: sexual functioning, antidepressant efficacy, and tolerability

In this double-blind, multicenter study, bupropion XL, a norepinephrine-dopamine reuptake inhibitor, and venlafaxine XR, a serotonin-norepinephrine reuptake inhibitor, were compared with regard to sexual functioning, efficacy, and tolerability. A total of 348 sexually active adult outpatients with depression were randomized to receive bupropion XL (titrated to a target dose of 300-450 mg/d) or venlafaxine XR (titrated to a target dose of 150-225 mg/d) for 12 weeks. Total scores on the primary dependent variable, the Changes in Sexual Functioning Questionnaire (self-report), increased for subjects receiving bupropion XL and decreased for those treated with venlafaxine XR; the mean change scores differed significantly between groups from week 2 onward. Among subjects with normal pretreatment sexual functioning, Changes in Sexual Functioning Questionnaire total scores remained essentially unchanged for the bupropion XL group but were decreased significantly for the venlafaxine XR group; mean change scores also differed between groups from week 2 onward. Although the therapies resulted in similar change on the 17-item Hamilton Depression Rating Scale, remission rates were significantly higher among those treated with bupropion XL (46%) versus venlafaxine XR (33%) (odds ratio, 1.93; 95% confidence interval, 1.07-3.46). Aside from adverse effects of venlafaxine XR on sexual function, both treatments were reasonably well tolerated. In conclusion, in this patient population (ie, relatively young, sexually active outpatients), bupropion XL was at least as effective as venlafaxine XR and had a significantly more favorable sexual side effect profile.     

Efficacy and tolerability of extended release quetiapine fumarate monotherapy in the acute treatment of generalized anxiety disorder: a randomized, placebo controlled and active-controlled study

The main objective of this study was to evaluate efficacy and tolerability of once-daily extended release quetiapine fumarate (quetiapine XR) monotherapy in generalized anxiety disorder (GAD). This was a 8 week randomized, 2-week follow-up, double-blind, placebo-controlled, and active-controlled study. Patients were randomized to quetiapine XR 150 (n=219) or 300 mg/day (n=207); escitalopram, 10 mg/day (n=213); or placebo (n=215). The primary endpoint was the change from randomization at week 8 in Hamilton Anxiety Rating (HAM-A) total score. Week 8 mean HAM-A total score was significantly reduced from randomization with quetiapine XR 150 mg/day (-13.9, P<0.001), 300 mg/day (-12.3, P<0.05) and escitalopram (-12.3, P<0.05) versus placebo (-10.7); significant improvements with quetiapine XR (150 and 300 mg/day) versus placebo (P<0.001) were also shown at day 4. At week 8, significant improvements versus placebo were observed in HAM-A psychic [quetiapine XR (both doses) and escitalopram] and somatic (quetiapine XR 150 mg/day and escitalopram) cluster scores and HAM-A response and remission rates (quetiapine XR 150 mg/day). Most common adverse events were dry mouth, somnolence and sedation (quetiapine XR), headache, and nausea (escitalopram). In patients with GAD, quetiapine XR (150 and 300 mg/day) demonstrated significant efficacy at week 8 with symptom improvement as early as day 4. We concluded that quetiapine XR safety and tolerability results were consistent with the known profile of quetiapine.     

Comparison of agomelatine and escitalopram on nighttime sleep and daytime condition and efficacy in major depressive disorder patients

Agomelatine, an MT1/MT2 receptor agonist and 5-HT2C receptor antagonist antidepressant, is known to have beneficial effects on subjective sleep in major depressive disorder patients. This international multicenter, randomized, double-blind study compared the effects of agomelatine (25-50 mg/day) and escitalopram (10-20 mg/day) on sleep polysomnographic parameters in major depressive disorder patients treated up to 24 weeks. A total of 138 outpatients were randomly allocated to agomelatine (n=71) or escitalopram (n=67). Treatment with agomelatine was associated with a reduction in sleep latency from week 2 onward. The difference between treatments was significant on all evaluations. Rapid eye movement latency was increased with escitalopram compared with agomelatine, with significant between-group differences at every visit. Agomelatine preserved the number of sleep cycles, whereas it was decreased with escitalopram with significant between-group differences at every visit. Assessments on visual analogue scales indicated that treatment with agomelatine improved morning condition, and reduced daytime sleepiness compared with escitalopram.17-item Hamilton depression rating scale total score was reduced in both groups, agomelatine was statistically noninferior to escitalopram at 6 weeks. Both treatments were well tolerated. This study showed that the clinical effects of agomelatine on sleep and wake parameters are different from that of escitalopram.     

A Randomized,Double-blind Study of the Efficacy and Tolerability of Extended Release Quetiapine Fumarate (Quetiapine XR) Monotherapy in Patients with Major Depressive Disorder

Objectives

Evaluate the efficacy and tolerability of once-daily extended release quetiapine fumarate (quetiapine XR) monotherapy in patients with major depressive disorder (MDD).

Methods

10-week (8-week active-treatment/2-week post-treatment), randomized, double-blind, placebo- and active-controlled study (D1448C00004). Patients received quetiapine XR 150 mg/day, escitalopram 10 mg/day, or placebo; patients with an inadequate response (<20% improvement in MADRS total score) at Week 2 received double-treatment dose. Primary endpoint: Week 8 change from randomization in MADRS total score. Secondary endpoints included: MADRS response (≥50% improvement) and remission (score ≤8), HAM-D total and Item 1, HAM-A total, psychic and somatic, CGI-S total, PSQI global, and Q-LES-Q-SF% maximum total scores; tolerability was assessed throughout.

Results

471 patients were randomized. No significant improvements in MADRS total score were observed at Week 8 (LOCF) with either active treatment (quetiapine XR, −17.21 [p=0.174]; escitalopram, −16.73 [p=0.346]) versus placebo (−15.61). There were no significant differences in secondary endpoints versus placebo, with the exception of Week 8 change in PSQI global score (quetiapine XR, −4.96 [p < 0.01] versus placebo, −3.37). MMRM analysis of observed cases data suggested that the primary analysis may not be robust. Most commonly reported AEs included: dry mouth, somnolence, and dizziness for quetiapine XR; headache and nausea for escitalopram.

Conclusions

In this study, neither quetiapine XR (150/300 mg/day) nor escitalopram (10/20 mg/day) showed significant separation from placebo. Both compounds have been shown previously to be effective in the treatment of MDD; possible reasons for this failed study are discussed. Quetiapine XR was generally well tolerated with a profile similar to that reported previously.     

Efficacy of extended release quetiapine fumarate monotherapy in patients with major depressive disorder: a pooled analysis of two 6-week, double-blind, placebo-controlled studies

Prospectively planned pooled analysis evaluating the efficacy of quetiapine extended release (XR) monotherapy in major depressive disorder (MDD). Data were pooled from two 6-week, randomized, double-blind, placebo-controlled studies of quetiapine XR in outpatients with MDD. The primary endpoint was Montgomery-?sberg Depression Rating Scale (MADRS) total score change from randomization at week 6. Other evaluations were MADRS response/remission, Hamilton Rating Scale for Anxiety, and subgroup analyses. A total of 968 patients were randomized to quetiapine XR, 150 mg/day (n=315), 300 mg/day (n=323), or placebo (n=330). The mean MADRS total score reductions from randomization were significant at week 6 with quetiapine XR, 150 mg/day (-14.7; P<0.001) and 300 mg/day (-14.7; P<0.001) versus placebo (-11.1), with significant reductions versus placebo from week 1 onward. Response rates (week 6): 52.7% (P<0.001) quetiapine XR 150 mg/day and 49.5% (P<0.001) quetiapine XR 300 mg/day versus placebo (33.0%). MADRS remission (score≤8; week 6): 23.5% (P=0.208) quetiapine XR 150 mg/day and 28.8% (P<0.01) quetiapine XR 300 mg/day versus placebo (19.4%). Quetiapine XR (both doses) significantly improved eight of 10 MADRS items versus placebo at week 6. The therapeutic effect of quetiapine XR was neither limited to nor driven by factors such as sex, age, or severity of depression. In patients with MDD, quetiapine XR (150 and 300 mg/day) monotherapy reduced depressive symptoms, with significant improvements compared with placebo from week 1 onward.     

Serotonin transporter promoter region polymorphisms do not influence treatment response to escitalopram in patients with major depression

Several studies and meta-analyses have implicated a polymorphism in the promoter region of the serotonin transporter (5-HTT) gene, 5-HTTLPR in treatment outcomes of selective serotonin re-uptake inhibitors in patients with major depression. In this study we investigated the impact of 5-HTTLPR and a functional SNP rs25531 on the treatment outcomes to escitalopram in depressive patients. The study sample consisted of 135 outpatients with major depressive disorder (mean age 31.1 ± 11.6 years, 68% females) treated with escitalopram 10–20 mg/day for 12 weeks. There were no significant associations between 5-HTT promoter region polymorphisms and response rate or mean change of depressive symptoms during escitalopram treatment. However we showed that patients carrying S allele of 5-HTTLPR may have increased risk for some side effects, including headache, induced by escitalopram medication.     

Evaluation of the cost effectiveness of escitalopram versus venlafaxine XR in major depressive disorder

AIM: To assess the relative cost effectiveness of escitalopram compared with venlafaxine XR in patients with major depressive disorder (MDD). METHODS: An economic evaluation was conducted alongside a double-blind, multinational, randomised clinical trial and examined the costs and quality of life of 251 patients taking escitalopram versus venlafaxine. Outpatients fulfilling criteria for MDD were randomised to receive oral escitalopram 10-20 mg/day or venlafaxine 75-150 mg/day for 8 weeks. Patient-reported outcomes (EuroQOL questionnaire, Quality of Life Depression Scale), use of medical services and absence from work (relating to the previous 3 months) were recorded at baseline, with repeated measurements at week 8. Unit costs in year values were applied to the resource utilisation data. A cost-effectiveness analysis was performed using the EuroQOL score as the effectiveness measure. The perspective was that of the healthcare payer, with a societal perspective considered in a sensitivity analysis. RESULTS: Statistically significant improvements in patient-reported outcomes (vs baseline) were observed in both groups after 8 weeks' treatment. Patients treated with escitalopram tended to report fewer problems on the EuroQOL dimensions than venlafaxine recipients. Mean per-patient costs in euros (euro, year 2003 values) for the escitalopram group, compared with the venlafaxine group, were 32% lower (110 euros vs 161euros) from a healthcare perspective, although this was not a statistically significant difference. Differences were related to lower drug acquisition costs and fewer hospitalisations for escitalopram than venlafaxine recipients. A multivariate model adjusting for baseline characteristics showed that escitalopram reduced direct costs compared with venlafaxine (p = 0.007). Bootstrapped distributions of the incremental cost-effectiveness ratios also showed similar effectiveness but lower costs for escitalopram compared with venlafaxine. Inclusion of indirect costs led to similar results. CONCLUSION: This prospective economic analysis suggests that escitalopram has similar effectiveness to venlafaxine in the treatment of MDD, but may be associated with lower healthcare costs. These findings are consistent with previously published economic evaluations.