Effective dose of escitalopram in moderate versus severe DSM-IV major depression

Introduction: Data from the three available placebo-controlled trials with fixed doses of escitalopram in the acute therapy of DSM-IV major depressive disorder (MDD) were pooled. The hypothesis tested was that escitalopram 10 mg/d might be an effective dose in moderate MDD, whereas escitalopram 20 mg/d might be needed in severe depression. Methods: The Montgomery-Asberg Depression Scale with all 10 items was used at baseline to differentiate between moderate (score range 22 to 29) and severe (scores >= 30) major depression. The MADRS(6) was selected as the primary efficacy parameter, using a standardised effect size of 0.40 as indicator of clincally significant response. Results: After 8 weeks of therapy, escitalopram 10 mg was superior to placebo, with a standardised effect size above 0.40 for patients with moderate depression, but not for those with severe depression. In contrast, 20 mg escitalopram was superior to placebo, with a standardised effect size above 0.40 in severe depression, but not in moderate depression. The MADRS(6) showed response (standardised effect sizes above 0.40) for moderate depression after two weeks of treatment with 10 mg: escitalopram and in severely depressed patients after 4 weeks with 20 mg escitalopram. Conclusion: Escitalopram 10 mg/d was the optimal dose for the treatment of moderate DSM-IV MDD, while escitalopram 20 mg/d was an effective dose in patients with moderate to severe depression.