Is escitalopram efficacious in the elderly?

The efficacy of escitalopram in the treatment of elderly patients with MDD has been demonstrated in several open-label studies (Savaskan et al., 2008; Gorwood et al., 2007; Rush & Rothschild, 2004; Möller et al., 2008). In addition, escitalopram has proven to be well tolerated in elderly patients (Rush & Rothschild, 2004; Möller et al., 2008).

In an open-label study of elderly patients with MDD (mean age 76.2 years) versus control subjects, escitalopram was shown to significantly improve affective symptoms (GDS score) and cognitive symptoms (Mini-Mental State Examination score) after only 4 weeks of treatment (Savaskan et al., 2008).

In a 12-week, open-label period prior to randomised treatment with escitalopram in a relapse prevention study in elderly patients Gorwood et al. (2007) showed a marked decrease in MADRS score; 81% of the patients were responders and 79.5% achieved remission (MADRS <12).

In a naturalistic clinical setting, the efficacy and safety of escitalopram in patients with MDD was evaluated (Rush & Rothschild, 2004). For the subgroup of elderly patients (784 patients, >60 years), the starting dose was 10 mg/day escitalopram for 4 weeks. This dose could be increased to a maximum of 20 mg/day at the discretion of the investigator to improve response. Depression was assessed using the physician rated CGI-I scale and the patient-rated Patient Global Evaluation (PGE) scale. Response was defined as a score of 1 (‘very much improved’) or 2 (‘much improved’) on the CGI-I or PGE scales. On the CGI-I scale response was observed in 71% of patients by week 8 of the study, and was consistent with the 69% patient-assessed response rate, as measured by the PGE scale. Escitalopram was generally well tolerated by the elderly patients, with only 12.9% discontinuing due to adverse events. Nausea (3.2%) and diarrhoea (2.2%) were the most frequent adverse events that led to discontinuation. The authors concluded that escitalopram appeared to be effective in the treatment of elderly patients with MDD and had a favourable safety profile.

Similar conclusions were drawn from another naturalistic, open-label,
8-week study of escitalopram, performed in a subgroup of elderly patients (≥65 years; 2050 patients) with depression (Möller et al., 2008). At week 8, the response rate was 63.9% when assessed via the short version MADRS scale (50% reduction from baseline), and 80.3% when assessed via CGI-I (much/very much improved, CGI-I ≤2). The remission rate at week 8 (short version MADRS score ≤12) was 48.6%. Furthermore, ~95% of patients and
physicians rated the tolerability of escitalopram as ‘good’ or ‘very good’ in this study.

The use of escitalopram versus citalopram in elderly patients with
MDD was investigated in a claims database study (691 patients, ≥65 years) (Wu et al., 2008). The study found that over a period of 6 months, elderly patients treated with escitalopram (n=459) were less likely to discontinue treatment (p=0.049) or switch to another second-generation antidepressant (p=0.001), as compared with citalopram-treated patients (n=232). Patients treated with escitalopram also had a significantly lower rate of hospital admissions than citalopram (31.2% versus 38.8%; p=0.045).

References:

Savaskan et al. Int J Neuropsychopharm 2008; 11: 381-388
Wu et al. Curr Med Res Opin 2008; 24(9): 2587-2595
Möller et al. poster presented 2008 CINP
Gorwood et al. Am J Geriatr Psychiatry 2007; 15: 581-593
Rush & Rothschild poster presented 2004 AAGP