Talk:Escitalopram/Archive 1

Archive 1

Archive 2

More on side effects

Is there a direct source for the claim that it causes weight gain (it's added as a throwaway remark, not even a complete sentence, at the end of the side effects section)? I'm well aware of anecdotal reports to that effect, but you know what they say--the plural of anecdote is not data. —The preceding unsigned comment was added by 216.193.172.224 (talk) 22:34, 7 December 2006 (UTC).

• The Australian Medicines Handbook 2007 lists "weight gain or loss" as a side effect for all members of the SSRI drug class including escitalopram. "Weight gain or loss" is again stated to be a common side effect in the specific drug information in the AMH. --Condolini 15:08, 10 March 2007 (UTC)

-- There were a problem with the formatting of the Side effect section. It was:

Citalopram and other SSRIs have been shown to cause sexual side effects in most patients, both males and females. Although usually reversible, these sexual side effects can sometimes last a very long time after discontinuation. This disorder is known as Post SSRI Sexual Dysfunction. It may also cause weight gain in certain people. It may cause dizziness after exercise in children.

I have now cleaned it up, but that means that the unsourced sentence "Another side effect is blurred or blended vision" is removed. Please put it in again if it is appropriate/sourced. -- fnielsen 09:42, 15 March 2007 (UTC)

Lundbeck and Forest Roles in Escitalopram Development

62.66.255.77 made the following addition to the history chapter "Escitalopram, particularly the technology to separate the two enantiomers of citalopram was developed and patented by Lundbeck. The clinical development was done in a close cooperation between Lundbeck and Forest Laboratories"

This is a controversial statement and should have been sourced properly. All I was able to find regarding the history of development of escitalopram is Lundbeck's 2000 annual report which on p28 states: Escitalopram for the treatment of depression is being developed in close cooperation with Lundbeck’s American partner, Forest Laboratories,Inc., No particular role of Lundbeck in separation of enantiomers or Forest in clinical development is mentioned. Furthermore, the US Patent Application 2005/0065207 on method of manufacture of escitalopram, which comprises the separation of enantiomers of citalopram, lists as the inventors both Lundbeck (Sommer, Nielsen and others) and Forest scientists (Assenza, Hariharan).Paul gene 01:27, 14 April 2007 (UTC)

What does "Esertia" mean?

What does "Esertia" mean? I just noticed the text on my box of Cipralex. Could it be a Spanish trade name of something like that? --81.227.68.28 15:44, 4 July 2007 (UTC)

[1] sez that it's Almirall Prodesfarma's version of escitalopram. --moof 23:18, 4 July 2007 (UTC)

Weight Gain/Loss

Does anyone know if this is a physiological response to the drug, or if it's because it affects appetite? I've put on weight whilst taking it, but I'm sure I haven't been eating anything extra Monkeyspearfish 17:20, 23 January 2007 (UTC)

I am not a doctor nor even scientist, just a fellow patient who has also put on weight, but could it be that another side effect (e.g. drowsiness), or the condition that caused you to get it prescribed, may have caused you to exercise less than you normally do, or otherwise changed your behaviour in such a direction? I know I exercise a lot less than I did before I got clinically depressed, but I can't just blame that on the drug. :) 82.111.241.126 08:49, 15 October 2007 (UTC)

Escitalopram in Southern California?

I have recently switched from private insurance over to Medi-Cal, and if anyone here is a Medi-Cal + Lexapro patient, you already know that Lexapro is not covered by Medi-Cal. However, my privately-insured psychiatrist is nice enough to still work with me, and he told me Lexapro has a generic, and that's when I learned about Escitalopram. Nonetheless, approximately 2 mos. ago I went into my privately-insured pharmacy where I was told by the pharmacy assistant helping me out that Lexapro's generic counterpart does not exist yet. I insisted that, perhaps my psychiatrist knows what he's talking about, but that only directed me right back to where I began.

Last Friday, Nov. 16, 2007, I contacted my local Medi-Cal-accepting pharmacy in order to place a refill for my Lexapro prescription. When I was told it would cost me nearly $130.00 for 7-days worth of Lexapro I asked about Lexapro's generic, to which I was again told how no generic exists yet for Lexapro. I asked the pharmacy assistant how long it might be before the generic would be available and she replied as follows, "Let's see, Lexapro came out maybe 3-years ago and it takes about 7-years for a generic to be released, therefore, Lexapro's generic will most likely be available within the next 4-years."

Can anyone please tell me whether or not he or she has been prescribed and received Escitalopram recently at a pharmacy located in Southern California? I only have a remaining 3-day supply of my Lexapro and I cannot afford to pay for my medication out of my pocket; my anxiety level is heightening due to the fact that I am anticipating, in a bad way, the sudden withdrawl symptoms of Lexapro, which is, what I was told by my pharmacist when I began taking Lexapro in 2005, some form of a heart condition.

I will greatly appreciate any help and/or information within the next week, please.

Thanks for reading!

KJCook1980 (talk) 19:07, 18 November 2007 (UTC) e-Mail Me, Kristen]

Wikipedia is not a doctor or a pharmacist. You need to take this question up with a professional. l'aqúatique ^talktome 21:00, 18 November 2007 (UTC)

I am not a doctor or pharmacist, but I can tell you that the formularies of at least two major insurance companies (Aetna, United Healthcare) treat citalopram as the generic equivalent of Lexapro/escitalopram; citalopram is off-patent and a big money-saver if it works for you. IMO it is not a true equivalent because of its greater side-effect profile (see footnote 2 of the Escitalopram article) for some people. Some have asked their doctor to switch them from Lexapro to Celexa (citalopram) to save money, but decided the side effects were not worth it. Of course, YMMV (your mileage may vary). Regards, --CliffC (talk) 21:16, 18 November 2007 (UTC)

Evaluating weight gain with antidepressants

One has to keep the following points in mind when evaluating weight gain with antidepressants:

• People taking placebo, gain 0.5-1% weight over a 1-2 years, so the weight gain with the antidepressant should be compared to placebo and not to the original weight
• Similarly, 3-6% of people taking placebo over 1-2 years experience clinically significant weight gain, usually defined as 7% weight gain (3.5 kg for a 70-kg person)
• Due to their side effects (nausea) SSRIs usually cause a weight loss during the first 1-2 months. This is then followed by weight normalization or gain. That is why it is important to evaluate weight gain after at least 3 months of SSRI therapy. Otherwise, even notorious paroxetine, for which a long term weight gain has been shown unequivocally, may appear to result in a weight loss. Paul gene (talk) 01:39, 5 January 2008 (UTC)

Stub

I'm labelling this a stub until a very important side effect profile can be given, as well as more general information about this drug. This article is mostly useless as is.J. M. 19:35, 28 March 2006 (UTC)

I disagree that this article is useless. It has loads of useful info, like the structure of the molecule, its class as an antidepressant, the disorders it is indicated for and the licence holders in various countries. I also think that the withdrawal effects should be checked against that reported in the medical literature, because it seems many users of escitalopram are reporting what they're experienced first hand here. Some of the symptoms described may be due to the recurrence of the underlying disorder, and some thought should be given to the relative frequency of each side effect - the information leaflet that comes with the drug has plenty of information on this. Ben 22:48, 28 March 2006 (UTC).

I also disagree that this article is useless. I used this article and the external links before I went on this medication, and they helped me immensely. While I did add withdrawal and side effects based on my personal experiences, I added a source which contained the information for validity. -Varco 23:30, 28 March 2006 (UTC)

Odd observance: there seems to be a link to a site wherein you can by Lexapro and other drugs at the end of the "Pharmacology" section of the Lexapro article. Is there any reason for it to be there? No capital letters or punctuation, so I wonder if someone snuck it in there. -FS —Preceding unsigned comment added by 74.192.115.15 (talk) 06:54, 6 January 2008 (UTC)

Lundbeck or Forest Labs

I'm noticing a revert war brewing regarding the development of citalopram. A discussion should take place here about it, instead of the edit summaries. Cheers. Wisdom89 _{(T / ^C)} 19:49, 17 April 2008 (UTC)

Indeed, revert wars are bad for the quality of the article. The citalopram article states that Lundbeck originally developed citalopram, and gives a reference, whereas no-one is providing references here. I'll check the citalopram reference now.

Ben (talk) 19:52, 17 April 2008 (UTC)

The citalopram reference, here, simply states that citalopram was developed in 1989, but doesn't say who did it!

Ben (talk) 19:55, 17 April 2008 (UTC)

Is this any help? (from lundbeck 1998 annual report) 24.36.35.188 (talk) 21:20, 18 April 2008 (UTC)

From a quick search of the patent literature, the earliest patents I can find mentioning citalopram (EP171943 in 1986 and EP347066 in 1989) were granted to scientists at Lundbeck. Deli nk (talk) 20:20, 17 April 2008 (UTC) ... Editing Wikipedia from a university library has its advantages. :)

Thanks for checking those for us, Deli. Is there one that we can reference?

Ben (talk) 20:48, 17 April 2008 (UTC)

Here they are:

Bogeso, Klaus Peter. Intermediate in the preparation of 1-(3-dimethylaminopropyl)-1-(4'-fluorophenyl)-1,3-dihydroisobenzofuran-5-carbonitrile. Eur. Pat. Appl. (1986), 12 pp. EP171943

Boegesoe, Klaus Peter; Perregaard, Jens. Preparation and isolation of antidepressant drug citalopram enantiomers and their pharmaceutical compositions. Eur. Pat. Appl. (1989), 11 pp. EP347066

Deli nk (talk) 21:07, 17 April 2008 (UTC)

There is no doubt that citalopram (Celexa) was developed solely by Lundbeck, Forest just did the paperwork for its FDA approval in the US. It is a bit more complicated with escitalopram. While Lundbeck separated the enantiomers first, it appears that Forest was involved in the development of the commercial process and its clinical development, see Talk:Escitalopram#Lundbeck and Forest Roles in Escitalopram Development above.

This says that Lundbeck supplied escitalopram to Forest. Articles in Pharma Times Jan 11 and 16 indicate that escitalopram is licensed by Forest from Lundbeck. 24.36.35.188 (talk) 22:02, 18 April 2008 (UTC)

I'm not so sure...

I don't think this was vandalism. I have family in the field and the problems with SSRIs and Suicide have been relatively well documented. It needs a citation, though. :D l'aqùatique ^talk 03:58, 12 December 2007 (UTC)

Thanks to Fnielsen who added references proving that the research to date has shown no significant association between escitalopram and suicide. So, clearly it was vandalism. Paul gene (talk) 11:06, 14 December 2007 (UTC)

Google "Lexapro suicide" to see how much talk there is about Lexapro and suicide. Even if you don't take any of it seriously, you have to assume that the edit referred to by l'aquatique is good faith and not vandalism. 24.36.35.188 (talk) 23:40, 18 April 2008 (UTC)

Agree, content disputes are not vandalism - even if it's trolling, which, in this case, it obviously is not. Please be careful when labeling something vandalism. Wisdom89 _{(T / ^C)} 00:35, 19 April 2008 (UTC)

Insomnia

This drug is also for sleep in people with primary insomnia. —Preceding unsigned comment added by Wjb (talk • contribs) 23:44, 6 July 2008 (UTC)

Patent status

A lot of visitors reading this page would probably like to know more information on the current patent status of Lexapro. Plus, links to articles about similar, related, or generic drugs might be nice 147.145.40.43 19:50, 19 March 2007 (UTC)

I too exercise less now than before but wouldn't give up the Lexipro as I'm convinced of its effectiveness. I may exercise less now because I'm less anxious which the constant exercise soothed- almost a form of self medication- yes a very good one. What I can do now is relax and spend time being still and enjoying it! —Preceding unsigned comment added by Mloomis2 (talk • contribs) 00:28, 5 July 2008 (UTC)

I have been taking Lepxpro for 6 months. At first this was the best drug to take and it lifted my mood dramatically. After some time I began to gain weight, and I have now gained 15kg since i started. Also of note I have been getting brain freezes, sexual side effects and headaches since using it. If I stop the medication I becme extreemly moody, get brain freezes and am very irritable. We have to think what we would likr more..happy pills or bucket loads of side effects??!! —Preceding unsigned comment added by 203.191.163.215 (talk) 03:11, 1 September 2008 (UTC)

Additional Information for Wiki

Escitalopram is distributed in Brazil as Lexapro by Lundbeck (not by Forest Labs.) —Preceding unsigned comment added by Erik Neves (talk • contribs) 16:36, 30 December 2008 (UTC)

Lexapro: (taken straight off the PI) http://www.lexapro.com/pdf/lexapro_pi.pdf

Lexapro® (escitalopram oxalate) is an orally administered selective serotonin reuptake inhibitor (SSRI).

Escitalopram is the pure S-enantiomer (single isomer) of the racemic bicyclic phthalane derivative citalopram.

Escitalopram oxalate is designated S-(+)-1-[3-(dimethyl-amino)propyl]-1- (p-fluorophenyl)-5-phthalancarbonitrile oxalate

Available as tablet or an oral solution – taken once daily Tablet available in 5, 10, 20mg dosages Identify each pill: 5mg – White/Off White, non-scored, film coated, imprint of “FL” on one side and “5” of the other side 10mg – White/Off White, scored, film coated, imprint on scored side with “F” on left and “L” on the right, on non-scored side there is a “10” 20mg – White/Off White, scored, film coated, imprint on scored side with “F” on left and “L” on the right, on non-scored side there is a “20” - overdose fatality is rare - even with 600mg+ per day

Pharmacodynamics: ie How it works The mechanism of antidepressant action of escitalopram, the S-enantiomer of racemic citalopram, is presumed to be linked to potentiation of serotonergic activity in the central nervous system (CNS) resulting from its inhibition of CNS neuronal reuptake of serotonin (5-HT). In vitro and in vivo studies in animals suggest that escitalopram is a highly selective serotonin reuptake inhibitor (SSRI) with minimal effects on norepinephrine and dopamine neuronal reuptake.

A generic video explaining differences between Celexa and its newer counterpart Lexapro – also covers how the SSRI works in the brain: http://www.lexapro.com/english/about_lexapro/isomer_animation.aspx

Peak Blood Levels – 5 hours after ingestion (absorption not affected by food)

Bioavailability – approx. 80%

Gender importance: None

Label Use: Major Depressive Disorder Generalized Anxiety Disorder (GAD)

Off Label Use : taken from www.ncbi.nlm.nih.gov - each is referenced accordingly Panic http://www.ncbi.nlm.nih.gov/entrez/query.fcgi?db=pubmed&cmd=Retrieve&dopt=AbstractPlus&list_uids=16953656&itool=iconabstr&query_hl=2&itool=pubmed_docsum Social Anxiety Disorderhttp://www.ncbi.nlm.nih.gov/entrez/query.fcgi?db=pubmed&cmd=Retrieve&dopt=AbstractPlus&list_uids=16953656&itool=iconabstr&query_hl=2&itool=pubmed_docsum OCD http://www.ncbi.nlm.nih.gov/entrez/query.fcgi?db=pubmed&cmd=Retrieve&dopt=AbstractPlus&list_uids=16953656&itool=iconabstr&query_hl=2&itool=pubmed_docsum Alzheimer’s http://www.ncbi.nlm.nih.gov/entrez/query.fcgi?db=pubmed&cmd=Retrieve&dopt=AbstractPlus&list_uids=16477587&itool=iconabstr&query_hl=2&itool=pubmed_docsum

Side Effects: Example of Side effect % from placebo controlled clinical trials for Major Depressive Disorder – for more graphs see PI http://www.lexapro.com/pdf/lexapro_pi.pdf

Body System/Adverse Effect Lexapro (N=715) Placebo (N=592) Dry Mouth 6% 5% Sweating Increased 5% 2% Dizziness 5% 3% Nausea 15% 7% Diarrhea 8% 5% Constipation 3% 1% Indigestion 3% 1% Abdominal Pain 2% 1% Influenza-like Symptoms 5% 4% Fatigue 5% 2% Insomnia 9% 4% Somnolence 6% 2% Appetite Decreased 3% 1% Libido Decreased 3% 1% Rhinitis 5% 4% Sinusitis 3% 2% Ejaculation Disorder 9% <1% Impotence (men) 3% <1% Anorgasmia (women) 2% <1% - for every side effect % increased with larger dosage size (ie 10mg -> 20mg)

Other more serious side effects- - Abnormal Bleeding - Hyponatremia - Mania/Hypomania - Seizures - Interference with Cognitive and Motor Abilities

Effects of Immediate Discontinuation of treatment: - Dysphoric Mood - Irritability - Agitation - Dizziness - Paresthesias - Anxiety - Confusion - Headache - Lethargy - Emotional Lability - Insomnia - Hypomania

When possible a gradual decrease in dose rather than abrupt change is recommended

Other Important Things - Increased suicidal thoughts and actions in children and teenagers - Do not take while pregnant – can lead to increased risk of o respiratory distress o cyanosis o apnea o seizures o temperature instability o feeding difficulty o vomiting o hypoglycemia o hypotonia/ hypertonia o hyperreflexia o tremor o jitteriness o constant crying

- Nursing mothers are also discouraged as drug exists in breast milk and can effect the child - Not to be taken with MAOIs (allow 14 days before treatment)

Apart from Off Label Section and generic video under the Pharmacodynamics section all information is found directly on the PI for Lexapro I realize its a bit of a laundry list - but with so many factors/topics it seemed the most concise way to deliver the infromation - Matt DeSousa - not sure why apon posting the graph and a few of the subjects became out of order - Im not sure how to fix this - sorry for the added difficulty in reading

"Clinical Superiority"

What does "Clinical superiority" mean? —Preceding unsigned comment added by Paralysisordeath (talk • contribs) 19:31, 13 August 2009 (UTC)

Recent New York Times article

A recent NYT article (Gardiner Harris (2009-09-02). "A Drug Maker's Playbook Reveals a Marketing Strategy". New York Times. Retrieved 2009-09-01.) calls into question many of the claims of this article. Notably (emphasis mine):

“ Forest’s executives and paid consultants have long implied that Lexapro is superior to Celexa and other antidepressants. But the Food and Drug Administration did not require Forest to test this theory in any statistically valid way. The F.D.A. views the two medicines as so interchangeable that the agency recently approved Lexapro’s use in depressed adolescents based in part on the results of a study Forest conducted using Celexa. ”

The article also discusses the aggressive and ethically questionable marketing tactics used for Escitalopram/Lexapro.

I've read similar allegations about this drug in other reputable sources. How can these be integrated into the article? Moxfyre (ǝɹʎℲxoɯ | contrib) 19:26, 1 September 2009 (UTC)

IMHO, the NYT article is biased and poorly researched. Its author skillfully uses seemingly correct statements to stretch the truth and to convey the impression of misconduct on Forest's part, where there was none. One example of such "reporting" is the above quote.

"But the Food and Drug Administration did not require Forest to test this theory in any statistically valid way" True, but the FDA never requires showing superiority to another antidepressant in the clinical trials of antidepressants. To the contrary, although FDA did not require Forest to show superiority, there are at least two controlled double-blind trials that did show statistically significant superiority of Lexapro over Celexa.

"The F.D.A. views the two medicines as so interchangeable that the agency recently approved Lexapro’s use in depressed adolescents based in part on the results of a study Forest conducted using Celexa." It is true that the FDA approved Lexapro's use using some data from Celexa trial. However, the NYT author commits a logical fallacy.

I guess, the FDA reasoned as follows: If "inferior" Celexa was effective for adolescent depression, then "superior" Lexapro should be effective too. That means that "inferior" Celexa can be replaced by "superior" Lexapro. However, such reasoning does not imply that the two drugs are interchangeable. "Superior" Lexapro cannot be replaced by "inferior" Celexa. If they were interchangeable, the FDA would have approved Celexa for adolescent depression based on the Lexapro data.

The Sceptical Chymist (talk) 11:05, 2 September 2009 (UTC)

I would also note the use of "some industry critics say" which are weasel words. Also, the original poster says the NYT article "calls into question many of the claims of this article" but I'm not seeing anything that directly refutes anything here. How about an example? Simishag (talk) 19:35, 2 September 2009 (UTC)

The aggressive marketing aspect of the NYT's article seems to be reliable enough. It is probably impossible for us to tease out the truth with respect to the claims made by the manufacturer in the absence of medical trials which directly compared the alternative generic drugs. I have added a small section which addresses the controversy about aggressive marketing. Fred Talk 03:52, 3 September 2009 (UTC)

See the Lunch and Learns section on page 31 $36 million budgeted. Fred Talk 04:09, 3 September 2009 (UTC)

This statement is incorrect: "claims made by the manufacturer in the absence of medical trials which directly compared the alternative generic drugs". There have been several direct comparisons of citalopram (Celexa) and escitalopram (Lexapro). In all of them escitalopram was significantly superior to citalopram. Escitalopram is also more cost-effective than generic citalopram (at least in European countries). Please read the literature.

PMID 15107657: In this study, we compared the efficacy of equivalent dosages of escitalopram and citalopram in the treatment of moderate to severe major depressive disorder (MDD), based on data from two, pooled, randomized, double-blind, placebo-controlled studies of escitalopram in which citalopram was the active reference. Significant differences in favour of escitalopram were observed for the MADRS and Clinical Global Improvement-Severity of Illness scores. More patients responded to and achieved remission with escitalopram than to citalopram. Escitalopram showed consistently superior efficacy compared to citalopram in the treatment of moderate to severe MDD on all efficacy parameters, and was similarly well tolerated.

PMID 18158074: OBJECTIVE: The aim of this study was to compare the efficacy and tolerability of escitalopram and citalopram in outpatients with major depressive disorder (MDD)...At study end, the mean (SE) change from baseline in MADRS total score was significantly greater in the escitalopram arm than in the 10- and 20-rag citalopram arms. Improvements were more marked in the severely depressed subgroup. Changes in the CGI-S and CGI-I scores and the rates of response and remission were significantly greater in the escitalopram group compared with those in the citalopram 10- and 20-mg groups.

PMID 17293711: The aim of this study was to assess the relative cost-effectiveness of escitalopram compared with citalopram in patients with major depressive disorder. An economic evaluation was conducted alongside a double-blind randomized clinical trial conducted by general practitioners and psychiatrists comparing fixed doses of escitalopram or citalopram. Statistically significant improvements were observed in patients treated with escitalopram. Mean per-patient costs for the escitalopram group, compared with the citalopram group, were 41% lower (96 euro vs. 163 euro; P<0.05) from a healthcare perspective.

PMID 14594439: Modelled pharmacoeconomic analyses found escitalopram to have a cost-effectiveness and cost-utility advantage over other SSRIs, including generic citalopram and fluoxetine and branded sertraline. These studies used a decision-analytic approach with a 6-month time horizon and were performed in Western Europe

PMID 19210149: Escitalopram was significantly more effective than comparators in overall treatment effect... Escitalopram was significantly superior to SSRIs... In comparison to SNRIs, the estimated difference in response was 68.3 vs. 59.0% (p = 0.0007) and for remission the difference was 57.8 vs. 50.5% (p = 0.0088)... The 8-week withdrawal rate due to adverse events was 5.4% for escitalopram and 7.9% for the comparators (p < 0.01)... CONCLUSIONS: In this meta-analysis, superior efficacy of escitalopram compared to SSRIs and SNRIs was confirmed, although the superiority over SSRIs was largely explained by differences between escitalopram and citalopram.

PMID 12665392: Escitalopram showed earlier and clearer separation from placebo than RS-citalopram, at one-quarter to half the dosage, in 8-week, placebo-controlled trials; had significantly better efficacy than RS-citalopram in a subgroup of patients with moderate MDD in a 24-week trial; and produced sustained response and remission significantly faster than venlafaxine extended release in patients with MDD.

PMID 15107719: OBJECTIVE: To determine if escitalopram is more effective than citalopram in patients with severe depression... DISCUSSION: This study shows that the new SSRI escitalopram has better efficacy in the treatment of severe depression than citalopram, its racemic parent. Mean differences between treatments groups were in favour of escitalopram for all scales. The benefits of escitalopram compared with citalopram, as demonstrated by both magnitude of effect and time of onset, are superior to the benefits of citalopram, an antidepressant drug with proven efficacy.

PMID 16944409: There was a significant superiority of escitalopram over citalopram in response rate and this difference increased with increasing baseline severity.

PMID 17454724: The total expected cost per successfully treated patient was lower for escitalopram than for citalopram. Robustness of the findings was verified in multivariate sensitivity analyses. For patients in primary care, escitalopram appears to be a cost-effective alternative to (generic) citalopram, with greater clinical benefit and cost-savings.

PMID 15922821: Treatment of patients with escitalopram instead of citalopram rendered a higher overall remission rate and first-line success rate. The mean cost per successfully treated patient was 15.7% lower for escitalopram compared with citalopram.

I looked at this one. It was done in the UK with respect to treatment by the National Health Service. The problem is that the prices charged for these drugs in the UK may be very different from those charge in the US. "a month’s supply of 5-milligram tablets of Lexapro costs $87.99 at drugstore.com, compared to $14.99 for a month’s supply of a generic version of Prozac." I suspect the NHS cost being used in the study is much lower than the US price. Fred Talk 16:08, 3 September 2009 (UTC)

I did specify that comparative cost-efficiency data is for Europe. The Sceptical Chymist (talk) 16:57, 3 September 2009 (UTC)

And many many more... The Sceptical Chymist (talk) 11:08, 3 September 2009 (UTC)

A claim made by sales representatives that escitalopram is better then generics in general or any generic in particular or any drug still under patent protection would require studies that involved comparing the effect of those drugs. The question for us, and probably impossible to answer in the absence of final court decisions or a settlement is what claims have been made (including here) and how fully they are backed up by research. A distinction must be drawn between superior efficacy and claims of superior efficacy made by sales representatives. Fred Talk 14:25, 3 September 2009 (UTC)

It is quite possible that the maker of a superior product could be successfully be charged with fraudulent marketing. We just don't do primary research and lack the capacity to evaluate the research that has been done. Fred Talk 15:45, 3 September 2009 (UTC)

Forest was charged with marketing Lexapro (escitalopram) to children and adolescents without approval. I agree that this information should be included. However, as for the question of superiority to generic citalopram, we should avoid repeating erroneous claims by NYT and use reliable medical sources. Please follow WP:MEDRS and WP:MEDMOS guidelines. In addition, I am not sure that this investigation deserves that much space as it is given now, please see WP:WEIGHT. The Sceptical Chymist (talk) 16:57, 3 September 2009 (UTC)

I am sure one small section is not out of line. Please review Wikipedia:Neutral point of view. It is equally important that we avoid including information resulting from studies financed by the manufacturer as they may not be reliable, but which are they? Who have they given money to? Is there a public relations firm or even an individual employed by the manufacture editing this article? Please see Public Relations Society of America Member Code of Ethics 2000. Fred Talk 18:36, 3 September 2009 (UTC)

This is essentially an ad hominem attack on the authors of the studies. You have not offered any evidence to suggest that the various universities and other organizations have compromised science or ethics in return for funding. If a study itself is flawed on a scientific basis, feel free to point that out. Simishag (talk) 19:43, 3 September 2009 (UTC)

Follow the money is not just an empty slogan. It is a principle that a Wikipedia editor is responsible for following. Fred Talk 20:51, 3 September 2009 (UTC)

What!?... The principle a good Wikipedian should follow here is to present neutral point of view based on reliable sources, see WP:5. The Sceptical Chymist (talk) 10:53, 4 September 2009 (UTC)

I am not an expert on pharmacology, drug research, or the pharmaceutical industry. Sceptical Chymist, thanks for pointing out the numerous studies on the relative effectiveness of Escitalopram. However, I very much agree with Fred that the New York Times article is noteworthy in describing the marketing strategies used to sell the drug. It's generally considered an extremely reputable source, and the claims about marketing appear to be very well-documented. In the United States, at least, the pricing and marketing of brand-name drugs is a topic of substantial debate and social impact, and so I believe it's proper to accord it significant space in this article. Moxfyre (ǝɹʎℲxoɯ | contrib) 23:55, 3 September 2009 (UTC)

I do not contest that description of Forest's marketing practices deserves to be presented in the article. They are widely known, and have been described in the press many times. However, I am against including in the article baseless innuendos implying that Lexapro is not superior to its close generic analog citalopram. The Sceptical Chymist (talk) 10:53, 4 September 2009 (UTC)

While the NYT article may be important with respect to Forest's marketing practices, it's not very relevant to a medical analysis of the drug. Lexapro will eventually lose its patent protection. Also, the NYT has a long history of uncritical reportage and outright fabrication, all the way from Walter Duranty to Jayson Blair. Let's not put them up on a pedestal. Simishag (talk) 22:42, 9 September 2009 (UTC)

Removing sourced information

In this edit The Sceptical Chymist (talk · contribs · deleted contribs · logs · filter log · block user · block log) removed material from a generally reliable published source. The language "the generic alternatives to the drug are much cheaper, but a substantial number of doctors continue to prescribe the much more expensive proprietary drug, apparently believing it is more effective" is not equivalent to the content implied in the comment that "removed a sentence stating that Lexapro is not superior". To support that comment there would have to be a reliable source which supported the claim that it is supperior, and even then Wikipedia:Neutral point of view would require inclusion of the point of view that there are effective generic alternatives. Fred Talk 21:01, 3 September 2009 (UTC)

I do not think that one article by NYT could trample the scientific consensus expressed in multiple peer-reviewed publications, including double-blind trials, reviews and meta-analyses. Citing an unsupported by any research innuendo that "substantial number of doctors continue to prescribe the much more expensive proprietary drug [Lexapro], apparently believing it is more effective" means giving space in the article to a fringe point of view.

Per WP:MEDRS guideline: Neutrality and no original research policies demand that we present the prevailing medical or scientific consensus, which can be found in recent, authoritative review articles or textbooks and some forms of monographs. Although significant-minority views are welcome in Wikipedia, such views must be presented in the context of their acceptance by experts in the field. The views of tiny minorities need not be reported.

Per WP:MEDRS guideline: The popular press is generally not a reliable source for science and medicine information in articles. Most medical news articles fail to discuss important issues such as evidence quality, costs, and risks versus benefits,[6] and news articles too often convey wrong or misleading information about health care. The Sceptical Chymist (talk) 10:42, 4 September 2009 (UTC)

According to a meta-analysis of 12 new-generation antidepressants, escitalopram and sertraline are the best in terms of efficacy and acceptability in the acute-phase treatment of adults with major depression. However, sertraline, generic Zoloft, may be a better choice in some instances:

Sertraline might be the best choice when starting treatment for moderate to severe major depression in adults because it has the most favourable balance between benefits, acceptability, and acquisition cost.

But there is a peer reviewed scientific study which makes the same point that was made in the NYT's article, the most favourable balance between benefits, acceptability, and acquisition cost favored the generic drug. Fred Talk 22:16, 4 September 2009 (UTC)

Looks acceptable for me. I am doing some style and formatting corrections specific to pharmacology articles. Also, I cannot agree that the article is written as advert. That has to be discussed and attempts to fix should be made before templating. The Sceptical Chymist (talk) 23:52, 5 September 2009 (UTC)

The statement "it has the most favorable balance" is not equivalent to "it is favored in all cases" or even "it is favored in some cases". "Balance" implies a tradeoff between costs and benefits, and for those who can afford the costs (which includes insurance), benefits may be the only consideration. Pharmaceutical costs are a separate topic in their own right, but compared to the costs of therapy, for example, even expensive patent medicines are relatively cheap. It is entirely possible that both patients and doctors could completely disregard the acquisition cost as a factor in the selection of medication; in my experience, doctors do this anyway and only prescribe a substitution if the patient requests it. A statement that drug X "might" be the best choice given the "balance" does not imply that drug X is superior. Simishag (talk) 22:51, 9 September 2009 (UTC)

Side effects profile - favourable to citalopram

This sentence "Escitalopram is noted for its high selectivity of serotonin reuptake inhibition and, as a result has fewer side effects not related to its serotonergic activity." is in the lead and not the body of the text. This claim appeared alot early on when it came out (and I remember not being entirely convinced at the time) - I think this is an important reference to update and also some discussion to be elaborated on in the side effects section. Casliber (talk · contribs) 20:02, 29 November 2009 (UTC)

PS: I have unprotected as the number of editors interested in the page has just tripled :) Casliber (talk · contribs) 20:02, 29 November 2009 (UTC)

• I note that the line that you refer to appears to be sourced from a 2002 paper that was supported by the Forest Laboratories. Snowman (talk) 20:28, 29 November 2009 (UTC)

• This did worry me and I did want a better reference and more robust discussion. Casliber (talk · contribs) 01:33, 30 November 2009 (UTC)

• If any new editors wish to contribute, it would be extremely helpful to provide references along with any new information added to this complex article. It is not essential, but new uses can make up a user name and a password and log in (no personal ID needed). This will provide a better user interface with some extra tools and your own user page and user talk page, where other wikipedians can communicate with you to help you to get started somewhere here. Snowman (talk) 21:05, 29 November 2009 (UTC)

• I have unprotected now, but creating an account is highly desirable. Casliber (talk · contribs) 01:33, 30 November 2009 (UTC)

I did not emphasise that above, but I agree it is preferable for editors to log in and use a wiki account. Snowman (talk) 18:01, 1 December 2009 (UTC)

Interaction with Prilosec?

I know some other SSRIs suffer from interactions with Prilosec such as Citalopram. They mention this in these articles. It seems that Escitalopram uses the same liver enzymes for metabolism and therefore MAY be subject to the same clearance issues. Can someone investigate and add (with an article for support). --1000Faces (talk) 02:39, 1 December 2009 (UTC)

Not mentioned in the prescription information. The Sceptical Chymist (talk) 03:17, 1 December 2009 (UTC)

I have added a brief note about the relevant information using BNF 58 as a reference. It is better to use the name omeprazole, because there are different trade names all over the world. Snowman (talk) 11:23, 1 December 2009 (UTC)

In general, these two drugs (escitalopram and citalopram) are promoted as relatively less likely to interact with other medications than other SSRIs are. Casliber (talk · contribs) 23:28, 1 December 2009 (UTC)

I think a confirmation that this increase in concentration is clinically significant is in order. For example, it may be 20-30%, which would make it irrelevant. This is yet another example of BNF being a muddle. The Sceptical Chymist (talk) 02:41, 2 December 2009 (UTC)

See PMID 16120067 and PMID 17375980: pharmacokinetics are indeed affected, but not clinically relevant. Fvasconcellos (t·c) 11:37, 2 December 2009 (UTC)

I have not said this increase was clinically significant and nor does the BNF - the entry on this interaction is not marked with a symbol to indicate that the interaction is harmful (see page 720 on how to use the BNF interactions section). As I explained, I just made a quick note about it following an enquiry (see above). Once again I find the BNF to be a reliable source, and I think that it is more reliable than the primary source currently used as a substitute reference, so I have opted to modify the text using both the primary souse (only about one study) and the secondary source, the secondary source being consistent with MEDMoS. Snowman (talk) 15:45, 2 December 2009 (UTC)

Then the most accurate way to portray it is with an explanatory statement that the change in serum levels of the latter drug is not clinically relevant (true of many drugs, with warfarin and being a notable exception). Casliber (talk · contribs) 19:40, 2 December 2009 (UTC)

Anyone can copyedit the article to improve the way it is written. I do not have enough information handy to comment on the interactions of escitalopram with coumarins or many other drugs. Snowman (talk) 23:02, 2 December 2009 (UTC)

Side effects

In the BNF these side effects are listed because they are common or serious side effects. Statistical significance depends on sample size and standard deviation, rather than a percentage from placebo. So I have restored a short referenced section about side effects. Snowman (talk) 11:40, 1 December 2009 (UTC)

Does it actually use the word "common" or equivalent for sinusitis, yawning, restlessness, abnormal dreams, and menstrual disturbances? Fro prescribing it, I'd agree with some - restlessness and dreams, but the others I query as common. How does the reference say it? Casliber (talk · contribs) 13:28, 1 December 2009 (UTC)

If you look at page ix under the heading "How to use the BNF", it explains the format used throughout the book - when side effects are listed for a drug the book lists "details of common and more serious side-effects". My addition to the article indicates common, less common, or rare side effects as featured in BNF 58 on page 216. The phrase "common side effects" is not seen on page 216, but by using the BNF 58 correctly (see page ix at the beginning of the book) the side effects listed before "less commonly" are the common side effects. To me the book indicates that the less common side effects that I have mentioned in the article are relatively more important, and the rare side effect is a serious side effect. I expect you know the BNF from when you used to work in the UK. I really think that the BNF would have only have side effects listed that are statistically significant. I expect the percentage frequencies of each side effect are available elsewhere, if anyone wants to evaluate this any further. Snowman (talk) 17:23, 1 December 2009 (UTC)

Did I mention working in the UK before? (wow, that slipped my mind...) It was 15 years ago, the MIMS in Australia is alot more abrupt. "Common" is frustratingly subjective - eg if I prescribe olanzapine or mirtazapine to someone, sedation is common (must be something like 9/10 people feel a sedating effect). Anyway, I will look around for other info, which I promised to do the other day, still working on articles about cockatoos is much more relaxing and less like work really...Casliber (talk · contribs) 20:01, 1 December 2009 (UTC)

I prefer editing hobby pages too. Be careful with using mirtazipine when there is a history of mania. Snowman (talk) 21:16, 1 December 2009 (UTC)

The frequency of manic switching on antidepressants is a common subject of debate among psychiatrists, with widely varying opinions. Casliber (talk · contribs) 23:16, 1 December 2009 (UTC)

Well, the MEDMOS states correctly that we should not clone drug formularies and only mention notable side effects. I submit that BNF is mistaken, and that is not a best source of drug information. I can find any number of reviews that say that the side effects mentioned by SMR are not significant or not mentioned at all because of their insignificance. The Sceptical Chymist (talk) 01:31, 2 December 2009 (UTC)

Anyone is welcome to bring side effect statistics to the discussion. Snowman (talk) 01:41, 2 December 2009 (UTC)

Hmmm SC, I'd say the BNF is a pretty significant source to ignore completely though. Casliber (talk · contribs) 02:34, 2 December 2009 (UTC)

I do not know, but it is the second time I encounter this problem where BNF lumps together all the side effects, relevant and not relevant. In any case, MEDMOS recommendation not to clone drug formularies applies here. The Sceptical Chymist (talk) 02:38, 2 December 2009 (UTC)

A quick look at the BNF will show a lot more side effects than I have listed in the article, so there is no cloning and no question that this is within MEDMOS guidelines. As far as I am aware all the side effects that I have listed are relevant, and I almost always find that the BNF (now in its 58th edition) to be reliable. Can anyone provide a link (including page fragment) to the MEDMOS guideline that is referred to? Snowman (talk) 10:02, 2 December 2009 (UTC)

Try to avoid cloning drug formularies such as the BNF and online resources like RxList and Drugs.com. Extract the pertinent information rather than just dumping low-level facts in a big list. For example, a long list of side effects is largely useless without some idea of which are common or serious., see WP:MEDMOS#Drugs. The Sceptical Chymist (talk) 04:43, 3 December 2009 (UTC)

Thank you for providing the link to MEDMos. I have intuitively provided the reader with information on how common the side effect are with common, less common, and rare groupings. The BNF lists more side effects. I would be irritated with a long list of side effects without indication of how common the side effects are. I think that my additions are in line with WP:MEDMoS. Snowman (talk) 10:37, 3 December 2009 (UTC)

There is no reason to provide the reader with less common and rare side effects unless they are dangerous or were the subject of attention (like suicides). The best for our proposes is the FDA definition of common side effects as "adverse effects with the incidence of >5% in the 20 mg/day group, which are at least twice of those with placebo and the 10 mg/day group".The Sceptical Chymist (talk) 11:58, 3 December 2009 (UTC)

I think that your recent edit adequately covers the common side effects, which are mostly predictable for a SSRI. It is good that you have provided the reader with the actual percentages, without going into too much detail of statistical significance. Some of the less common side effects seemed unusual for a SSRI, such as sinusitis, which I think should have a special mention with some of the other less common side effects. Aggression may be rare, but I expect that it is significant when it occurs, so I think that should be included in the article too. I have not got any detailed data on the "aggression side effect" handy - can you find anything? Snowman (talk) 15:37, 3 December 2009 (UTC)

Thank you for agreeing to compromise. No, sinusitis is a usual side effect for any drug or placebo because over a period of several weeks some people are bound to get it. The slight excess of sinusitis for escitalopram (4% vs 2-3%, as far as I remember) is a statistical fluke. I believe that aggression has not been documented in clinical trials of E. (Possibly, it has been in children and adolescents, because it is a class effect of SSRIs for them.) However, there should be case reports/postmarketing reports in the literature, and aggression should be described based on and sourced to that literature. Simple reference to BNF would be inadequate.The Sceptical Chymist (talk) 11:57, 4 December 2009 (UTC)

Incorrect wording - Pharmacology section

The third sentence might have the word 'escitalopram' used incorrectly in two instances. Shouldn't the third sentence read: 'Another enantiomer of citalopram (R-citalopram) counteracts to a certain degree the serotonin-enhancing action of citalopram. As a result, escitalopram is a more potent antidepressant than citalopram, which is a mixture of S-citalopram and R-citalopram' ? Infojunkie2 (talk) 00:14, 9 May 2010 (UTC)

Other

Deleting references to "Allan Mason" pending any citations. I can find no references to his involvement in the development of Escitalopram, and "Jocette Docherty" shows up exactly 0 times in Google. --JohnRDaily 06:04, 31 Jul 2004 (UTC)

Heck, removing everything but the bare minimum, since I can't verify anything, and clearly the original author was careless at best, and disingenuous at worst. Even the trademark information was incomplete; Forest Pharmaceuticals has the Lexapro trademark in the U.S., Lundberg in Australia. --JohnRDaily 06:18, 31 Jul 2004 (UTC)

I'm coming off Escitalipram now, I'd like a section for withdrawel symptons since the doctor didn't warn me about them. I'm going to add one now (electric shock-like nervous system pulses), I hope this is considered valid. The effects described are based on personal experience and consultation with a professional who has witnessed the same effects in other patients. --rgc

It would be good to make sure that those symptoms are cited in the linked web pages, and if not, find one that does, so that the information is properly sourced. It would also be great if you could include more side-effects and withdrawal symptoms, again with sources. -JohnRDaily 01:56, 18 February 2006 (UTC)

I too am coming off of the drug; I've added mroe withdrawal symptoms based on my own experience, but I've also included a source. --Varco 05:37, 8 March 2006 (UTC)

I also had the "little electric shocks" when coming off of Cipralex quite fast. In fact, that was exactly how I described them. Quite relieving to read this and find out that I wasn't the only one. The description concerning the shocks in the article is accurate according to my experience.

it seems a common experience from missing a dose, or going off the medication, for both Escitalipram and Sitalipram, and Wikipedia has a section in the SSRIDS article about the "Brain Shivers" or "Brain Zaps" --http://en.wikipedia.org/wiki/SSRI_discontinuation_syndrome#.22Brain_zaps.22_and_sensations 199.214.18.223 (talk) 23:00, 2 December 2010 (UTC)

Escitalopram is now also available under the name Esipram in Australia. See [2]. 59.101.230.61 11:30, 12 February 2007 (UTC)

Understanding possible side-effects - anecdotal claims only

I've been trying to research any reported side-effects with this medication, but I can't find anything that compares to my own experiences with Lexapro. My family physician prescribed it to help me cope with panic disorder. At the time, I was having frequent panic attacks, felt strains all throughout my body, felt tingling sensations on my left side at all times, had the occasional dizzy spell, felt a strange lack of balance and co-ordination, and occasionally felt like I was floating. (rather, like the gravity was being turned up and down) My doctor assured me that ALL of these symptoms were manifestations of anxiety. I decided to try Lexapro per her suggestion, and did notice some improvement within a few weeks. The symptoms seemed to have mostly disappeared.

I started at 2.5 mg, and worked my way up to 5 mg. About a month into it, I woke-up one night and had the most frightening experience of my life. My arms and chest felt extremely hollow, and I felt like my body was expanding and contracting at the same time. I ran into the bathroom and looked in the mirror, and everything just felt absolutely crazy. It was like I was looking at myself from a third-person perspective, or I was completely outside of my own body. It wasn't a hallucination in any sense, but a really strange sensation from within my own body. Although difficult to completely articulate, it mostly felt like my brain was registering that my arms did not exist. I could see and feel them, but it was "wrong" that they were there.

I almost called an ambulance, but managed to calm down once I realized I wasn't in any immediate danger. The symptoms did not subside at any point. I went to the doctor and tried to articulate what was going on, but she dismissed any suggestion that Lexapro could possibly be responsible for what I was experiencing. In fact, she suggested I was developing schizophrenia. There is no history of this in my family, and I was not experiencing any symptoms consistent with schizophrenia.

I spoke with a therapist about what I was experiencing, and whether or not it could be another manifestation of anxiety. Because the strange sensations I was now having literally lasted all day long — and for several months — she (my therapist) wasn't convinced that they were related to G.A.D., or panic disorder. It was only after quitting Lexapro cold-turkey that I gradually began to improve. There was a lot of strangeness from the Lexapro withdrawal, but the psychosomatic delusions of my arms "not being there" slowly subsided over a period of months.

There are a few other possibilities that might correlate with what I experienced: I have thyroid disease, and take 75 mcg of levothyroxin daily. That same night, I was experiencing a lot of congestion due to the weather, and took a couple of Alkaseltzer Cold Plus tablets. Because this contains a decongestant, there's a warning about taking it when you have thyroid disease. Since it had not bothered me in the past, I didn't think anything of it. It may be possible that the decongestant either interacted with my thyroid medication, or the Lexapro. It may be possible that all three were just a bad combination. Either way, it's an interesting coincidence.

I don't believe that I spontaneously developed psychosomatic delusions because of mental illness. I have been struggling with panic disorder for some time, and I am intimately familiar with each and every symptom of a panic attack. I've woken to panic attacks several times. This experience was neither here nor there. Thankfully, I have made a full recovery from the psychosomatic problems; but I think it's worth mentioning that these psychosomatic problems may be a possible side-effect for some people. I wish my doctor would try to explore the possibility, and help me understand why these issues spontaneously appeared. I would rather not repeat that experience. Knowing what caused it will help me to avoid it in the future. 70.153.123.65 (talk) 17:28, 28 May 2011 (UTC)

withdrawals!

take only as a last resort..this drug has AWFUL WITHDRAWALS. IM SOO SORRY I EVEN STARTED IT :'( —Preceding unsigned comment added by 86.40.251.37 (talk) 19:05, 18 April 2011 (UTC)

All anti-depressants have awful withdrawals, unfortunately. It largely depends on how slowly you taper off the medication. If you quit cold-turkey, it's probably going to be the roughest experience; if you quit over a period of several months, you're not as likely to notice the withdrawals. Just bear this in mind if you decide to try other medications in the future. I can certainly understand the desperation to quit a medication that has bad side-effects, though. 70.153.123.65 (talk) 17:32, 28 May 2011 (UTC)

Propose updating the medical uses section to state

Escitalopram is primarily used for the treatment of major depressive disorder and general anxiety disorder in adults. There is some evidence favouring escitalopram over the antidepressents citalopram and fluoxetine in the first two week of major depression. Concerns of sponsorship bias with the studies is however noted. In another review escitalopram and sertraline had the highest rate of efficacy and acceptability among adults receiving treatment for major depression with second-generation antidepressants.

We typically just state the conclusions of review articles without mentioning in what journal they where published.Doc James (talk · contribs · email) 13:48, 11 October 2011 (UTC)

My (Rhproofer's) Edits

Regarding my section on "Lexapro Versus Citalopram", stating the existence of primary research articles is not drawing a conclusion from those articles. Here I have used the the primary articles as an adjunct to the secondary Independent article, "NHS pays millions of pounds more than it needs to for drugs", in order to rebut its claim of only one independent study. I have not drawn the conclusion that the Independent is wrong. I have simply added properly cited contradictory information; therefore, I have not synthesized my own ideas--not done any original research. If you like, I can restate the introductory phrase, and last two sentences to avoid any possibility of violating WP:SYNTH.

While the Independent is not a primary source, it is a dubious source. Whoever decided to use the Independent as the sole source for the idea that there has been only one independent study of Lexapro versus citalopram should take responsibility for digging further. Otherwise, the information on Wikipedia is biased and inaccurate. WP:MEDRS says, "Ideal sources for such content includes general or systematic reviews published in reputable medical journals, academic and professional books written by experts in a field and from a respected publisher, and medical guidelines or position statements from nationally or internationally recognised expert bodies." The Independent is none of these. However, some of my citations were general or systematic reviews published in reputable medical journals.

Regarding my section on "Lexapro Versus Generics", the FDA is a nationally recognized, government institution, and I have not drawn any conclusions not stated or implied in the FDA material I cited.

Please leave my edits, as they comply with policy, and they are valuable to readers. Previous authors seem to have taken a strong view that Lundbeck and Forest Laboratories "evergreened" citalopram and should be villified. They appear to not want any other viewpoint to appear on the page.

Finally, I apologize for violating the 3RR rule. I was not aware of it. In the future, I will not revert without properly discussing the issue.

Thank you.

Rhproofer (talk) 04:36, 12 October 2011 (UTC)

In this edit [3] The text added is

(It is easy to find independent studies that compare escitalopram with citalopram. See the "Lexapro Versus Citalopram (Generic for Celexa)" section below.)==Lexapro Versus Citalopram (Generic for Celexa)==

An number of studies address the question of the efficacy of Lexapro versus citalopram, and some of the studies give conflicting results:

Efficacy of escitalopram in patients with severe depression: a pooled analysis. Int J Clin Pract. 2005 Mar;59(3):268-75.

[Efficacy of escitalopram and severity of depression: new data]. Encephale. 2009 Dec;35(6):577-85.

Escitalopram in the treatment of major depressive disorder: a meta-analysis. Curr Med Res Opin. 2009 Jan;25(1):161-75.

Comparative efficacy of escitalopram in the treatment of major depressive disorder. Neuropsychiatr Dis Treat. 2011;7:39-49. Epub 2011 Feb 1.

Is escitalopram really relevantly superior to citalopram in treatment of major depressive disorder? A meta-analysis of head-to-head randomized trials. Croat Med J. 2010 Feb;51(1):61-73.

This list is not meant to be complete. It is only a sampling, and evidence that the question of Lexapro versus citalopram has been the subject of scientific study and debate.

Lexapro Versus Generics

Because Lexapro is a brand drug, it is subject to different standards for Food and Drug Administration (FDA) approval than generics. Note that the FDA only requires a 95% likelihood that a generic drug is equivalent to the reference listed drug (brand drug) in order for the generic to be approved. Specifically, the FDA Orange Book, 31st Edition states on page x, "The current practice of carrying out two one-sided tests at the 0.05 level of significance ensures that there is no more than a 5% chance that a generic product that is not truly equivalent to the reference will be approved." Moreover, only the maker of a generic drug is required to perform studies as to bioequivalency. Page viii of the Orange Book says, "Under the Drug Price Competition and Patent Term Restoration Act of 1984, manufacturers seeking approval to market a generic drug product must submit data demonstrating that the drug product is bioequivalent to the pioneer (innovator) drug product."

This is not how we write encyclopedic text. We do not simply list studies which have been done. The FDA comment is not specific to the medication is question. This content in the current form will thus not be returned. Doc James (talk · contribs · email) 14:33, 12 October 2011 (UTC)

References