Paroxetine versus Venlafaxine and Escitalopram in Korean Patients with Major Depressive Disorder: A Randomized, Rater-Blinded, Six-Week Study
Young Sup Woo 1, Roger S McIntyre 2, 3, Jung-Bum Kim 4, Min-Soo Lee 5, Jae-Min Kim 6, Hyeon Woo Yim 7, Tae-Youn Jun 1*
1Department of Psychiatry, College of Medicine, The Catholic University of Korea, Seoul, Republic of Korea, 2Mood Disorders Psychopharmacology Unit, University Health Network, Toronto, Ontario, Canada, 3Department of Psychiatry, University of Toronto, Toronto, Ontario, Canada, 4Department of Psychiatry, Keimyung University, School of Medicine, Daegu, Republic of Korea, 5Department of Psychiatry, College of Medicine, Korea University, Seoul, Republic of Korea, 6Department of Psychiatry, Chonnam National University Medical School, Kwangju, Republic of Korea, 7Department of Preventive Medicine, College of Medicine, The Catholic University of Korea, Seoul, Republic of Korea
Received: December 22, 2016; Revised: March 15, 2017; Accepted: March 17, 2017; Published online: March 17, 2017.
© The Korean College of Neuropsychopharmacology. All rights reserved.

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 (OR = 2.43, 95% CI = 1.42–4.16 for MADRS, and 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 finding suggest that paroxetine might be superior to escitalopram in Korean MDD patients. Further studies should be conducted to draw a definite conclusion.
Keywords: Paroxetine, Venlafaxine, Escitalopram, Major depressive disorder, Korean


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