Clin Psychopharmacol Neurosci.  2017 Nov;15(4):391-401. 10.9758/cpn.2017.15.4.391.

Paroxetine versus Venlafaxine and Escitalopram in Korean Patients with Major Depressive Disorder: A Randomized, Rater-blinded, Six-week Study

Affiliations
  • 1Department of Psychiatry, College of Medicine, The Catholic University of Korea, Seoul, Korea. tyjun@catholic.ac.kr
  • 2Mood Disorders Psychopharmacology Unit, University Health Network, University of Toronto, Toronto, Ontario, Canada.
  • 3Department of Psychiatry, University of Toronto, Toronto, Ontario, Canada.
  • 4Department of Psychiatry, Keimyung University School of Medicine, Daegu, Korea.
  • 5Department of Psychiatry, Korea University College of Medicine, Seoul, Korea.
  • 6Department of Psychiatry, Chonnam National University Medical School, Gwangju, Korea.
  • 7Department of Preventive Medicine, College of Medicine, The Catholic University of Korea, Seoul, Korea.

Abstract

OBJECTIVE: The purpose
of this study was to compare the efficacy and safety of escitalopram, paroxetine and venlafaxine in Korean patients with major depressive disorder (MDD).
METHODS
A total of 449 Korean MDD patients were recruited in a six-week, randomized, rater-blinded, active-controlled trial and were evenly randomized to paroxetine, venlafaxine, or escitalopram treatment.
RESULTS
When comparing the mean difference for the Montgomery-Åsberg Depression Rating Scale (MADRS) and the Hamilton Depression Rating Scale (HDRS) total scores during six weeks, paroxetine (−6.4±0.4, and −5.4±0.4, respectively) was found to be significantly superior to escitalopram (−3.7±0.5 and −3.1±0.4, respectively). Venlafaxine had a significantly lower MADRS total score (−5.4±0.4) than escitalopram. When adjusting baseline variables, the response, according to the MADRS and HDRS scores, in the paroxetine group was greater than that for the escitalopram group (odds ratio [OR]=2.43, 95% confidence interval [CI]=1.42–4.16 for MADRS; and OR=2.32, 95% CI=1.35–3.97 for HDRS) and the venlafaxine group (OR=1.94, 95% CI=1.17–3.21 for MADRS; and OR=1.71, 95% CI=1.03–2.83 for HDRS). Despite that the overall tolerability was high and similar among the three groups, a total of 268 subjects (59.7%) prematurely discontinued treatment, representing the main limitation of the present study.
CONCLUSION
Although a low study completion rate limits generalizability, our findings suggest that paroxetine might be superior to escitalopram in Korean MDD patients. Further studies should be conducted to draw a definite conclusion.

Keyword

Paroxetine; Venlafaxine; Escitalopram; Major depressive disorder; Korean
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