Clinical Psychopharmacology and Neuroscience Papers in Press available online.

 
Efficacy and safety of escitalopram, desvenlafaxine, and vortioxetine in the acute treatment of anxious depression: A randomized rater-blinded 6-week clinical trial
Cheolmin Shin 1, Sang Won Jeon 2, Seung-Hoon Lee 3, Chi-Un Pae 4, Narei Hong 5, Hyun Kook Lim 6, Ashwin A. Patkar 7, Prakash S. Masand 8, Hyonggin An 9, Changsu Han 10,*
1Department of Psychiatry, Korea University Ansan Hospital, Korea University College of Medicine, Seoul, Republic of Korea, 2Department of Psychiatry, Kangbuk Samsung Hospital, Sungkyunkwan University School of Medicine, Seoul, Republic of Korea , 3Department of Psychiatry, Veterans Health Service Medical Center, Seoul, Republic of Korea, 4Department of Psychiatry, Bucheon St. Mary's Hospital, College of Medicine, The Catholic University of Korea, Seoul, Republic of Korea, 5Department of Psychiatry, Hallym University Sacred Heart Hospital, Anyang, Korea, 6Department of Psychiatry, Yeouido St. Mary’s Hospital, College of Medicine, The Catholic University of Korea Seoul, Seoul, Republic of Korea, 7Department of Psychiatry and Behavioral Sciences, Duke University Medical Center, Durham, North Carolina, USA, 8Global Medical Education, New York, NY, USA, 9Department of Biostatistics, Korea University College of Medicine, Seoul, Republic of Korea, 10Department of Psychiatry, Korea University Guro Hospital, Korea University College of Medicine, Seoul, Republic of Korea
Abstract
Objectives: Anxious depression is associated with greater chronicity, higher severity of symptoms, more severe functional impairment, and poor response to drug treatment. However, evidence for first-choice antidepressants in patients with anxious depression is limited. This study aimed to compare the efficacy and safety of escitalopram, desvenlafaxine, and vortioxetine in the acute treatment of anxious depression.
Methods: Patients (n=124) with major depressive disorder and high levels of anxiety were randomly assigned to an escitalopram treatment group (n=42), desvenlafaxine treatment group (n=40), or vortioxetine treatment group (n=42) in a 6-week randomized rater-blinded head-to-head comparative trial. Changes in overall depressive and anxiety symptoms were assessed using the 17-item Hamilton Depression Rating Scale (HAMD) and Hamilton Anxiety Rating Scale (HAMA), respectively.
Results: Patients demonstrated similar baseline-to-endpoint improvement in scores and similar response and remission rates for HAMD and HAMA. Analysis of the individual HAMD items revealed that desvenlafaxine significantly reduced anxiety somatic scores (p=0.013) and hypochondriasis scores (p=0.014) compared to escitalopram. With respect to the individual HAMA items, desvenlafaxine treatment showed significantly lower scores for respiratory symptoms (p=0.013) than escitalopram treatment and cardiovascular symptoms (p=0.005) than vortioxetine treatment. The treatments were well tolerated, with no significant differences.
Conclusions: Our results indicated no significant differences in the efficacy and tolerability of escitalopram, desvenlafaxine, and vortioxetine in this subtype of patients with anxious depression during the acute phase of treatment.
Accepted Manuscript [Submitted on 2021-09-14, Accepted on 2021-10-20]