Is escitalopram better than paroxetine for treatment of OCD

In a study by Stein et al. (2007)  the treatment efficacy of escitalopram, paroxetine and placebo over 24 weeks was investigated. This 24-week study included a total of 466 patients (from 58 centres in seven countries) with a primary diagnosis of OCD and a Y-BOCS mean entry score of approximately 27 , i.e. moderately to severely ill; the mean duration of illness was about 14 years. Patients were randomised to placebo, escitalopram 10 mg/day, escitalopram 20 mg/day or paroxetine 40 mg/day – the recommended dose for OCD. Up-titration to escitalopram 20 mg/day and paroxetine 40 mg/day was allowed.

Escitalopram 20 mg/day showed a statistically significant improvement in outcome measures from week 6 onwards, including the primary efficacy endpoint at 12 weeks and the study endpoint at 24 weeks.
The data suggest a dose–response effect, with the 10 mg/day dose of escitalopram showing less robust results, but it is worth noting that this dose still achieved significant efficacy. Continued improvement throughout the study was evident in all the active treatment groups in contrast to the placebo group.

Further analyses showed that escitalopram 20 mg/day compared favourably with paroxetine 40 mg/day regarding response and remission rates as measured by the Y-BOCS ratings and global clinical impression. Significant response to treatment (defined as CGI-I 1 or 2) was observed earlier for escitalopram 20 mg/day (at week 8) than for paroxetine 40 mg/day (at week 12). Significant response was evident for the escitalopram 10 mg/day group from week 16.

References:

Stein et al. Curr Med Res Opin 2007; 23: 701-711