Clinical experience with escitalopram, a stereoisomer antidepressant

The clinical benefits of escitalopram have been seen in well-designed double-blind, placebo-controlled clinical trials among patients with major depressive disorder, with or without symptoms of anxiety. Partial resolution of depressive symptomatology was observed as early as 1-2 weeks after beginning escitalopram therapy. The tolerability profile of the 10 mg dosage was comparable to placebo in terms of discontinuation rates. In those trials employing citalopram as a comparator, escitalopram appeared to be potentially more effective than the parent compound, as well as having a more rapid onset of action. Long-term data (36 weeks) showed that escitalopram significantly reduced the risk of relapse. Preliminary results of trials involving escitalopram in the treatment of generalized anxiety disorder, panic disorder and social anxiety disorder suggest that this agent may also have a therapeutic role to play in these conditions as well. The development and availability of SSRIs has greatly expanded the role of drug therapy in treating depressive and anxiety disorders. SSRIs are efficacious, easy to use and well tolerated, especially in comparison with previous agents. This therapeutic class has helped enhance patient compliance, particularly over a long-term course of treatment as is frequently necessary in treating these conditions. Despite a common mechanism of action, the SSRIs are heterogeneous compounds, so that patients who do not respond to one member of this class may respond to another. Pursuing a single isomeric form of a known compound offers the potential to improve therapeutic options, by eliminating adverse events that may be associated with an isomer that contributes little, if at all, to the racemate's therapeutic effects. Escitalopram has demonstrated a robust effect on symptoms of depression and anxiety, early onset of effect, and a good safety and tolerability profile. As such, this new agent represents an important addition to the therapeutic armamentarium for the treatment of depressive disorders.