Temporal Profiles and Dose-Responsiveness of Side Effects with Escitalopram and Duloxetine in Treatment-Naïve Depressed Adults.

• Type of Material: Article
• Authors: Philip E. Polychroniou, Emory University; Helen S Mayberg, Emory University; W Edward Craighead, Emory University; Jeffrey Rakofsky, Emory University; Vivianne Aponte Rivera, Tulane University; Ebrahim Haroon, Emory University; Boadie W Dunlop, Emory University
• Language: English
• Date: 2018-07-17
• Publisher: MDPI
• Publication Version: Final Published Version
• Copyright Statement: © 2018 by the authors.
• License: Creative Commons Attribution 4.0 International
• Final Published Version (URL): http://dx.doi.org/10.3390/bs8070064
• Title of Journal or Parent Work: Behavioral Sciences
• ISSN: 2076-328X
• Volume: 8
• Issue: 7
• Start Page: 64
• End Page: 64
• Grant/Funding Information: This research was funded by the National Institutes of Health, grant numbers P50 MH077083, R01MH080880, UL1 RR025008, and M01 RR0039.; Forest Labs and Elli Lilly Inc. donated the study medications, escitalopram and duloxetine, respectively, but were otherwise uninvolved in study design, data collection, data analysis, or interpretation of findings.
• Keywords: drug toxicity; medication adherence; adverse drug reaction; antidepressant; serotonin uptake inhibitors
• Research Categories: Psychology, Behavioral

Abstract

Side effect profiles of antidepressants are relevant to treatment selection and adherence among patients with major depressive disorder (MDD), but several clinically-relevant characteristics of side effects are poorly understood. We aimed to compare the side effect profiles of escitalopram and duloxetine, including frequencies, time to onset, duration, dose responsiveness, and impact on treatment outcomes. Side effects occurring in 211 treatment-naïve patients with MDD randomized to 12 weeks of treatment with flexibly-dosed escitalopram (10⁻20 mg/day) or duloxetine (30⁻60 mg/day) as part of the Predictors of Remission in Depression to Individual and Combined Treatments (PReDICT) study were evaluated. Escitalopram- and duloxetine-treated patients experienced a similar mean number of overall side effects and did not differ in terms of the specific side effects observed or their temporal profile. Experiencing any side effect during the first 2 weeks of treatment was associated with increased likelihood of trial completion (86.7% vs. 73.7%, p = 0.045). Duloxetine-treated patients who experienced dry mouth were significantly more likely to achieve remission than those who did not (73.7% vs. 44.8%, p = 0.026). Side effects that resolved prior to a dose increase were unlikely to recur after the increase, but only about 45% of intolerable side effects that required a dose reduction resolved within 30 days of the reduction. At the doses used in this study, escitalopram and duloxetine have similar side effect profiles. Understanding characteristics of side effects beyond simple frequency rates may help prescribers make more informed medication decisions and support conversations with patients to improve treatment adherence.