What are the effects of long-term use of Escitalopram (Citalopram)

From the Guidelines

Long-term use of Escitalopram (Citalopram) can be associated with increased risk of QT prolongation, particularly at daily doses exceeding 40 mg/d, and should be avoided in patients with long QT syndrome. When considering the effects of long-term use of Escitalopram, it is essential to weigh the benefits against the potential risks, including discontinuation syndrome, drug-drug interactions, and increased risk of suicidal thinking or behavior compared to other SSRIs 1.

Key Considerations

• Escitalopram may have the least effect on CYP450 isoenzymes compared with other SSRIs, resulting in a lower propensity for drug interactions 1.
• A discontinuation syndrome has been reported following missed doses or acute discontinuation of shorter-acting SSRIs, including citalopram 1.
• Regular monitoring by a healthcare provider is crucial during long-term use to assess ongoing benefit, manage side effects, and evaluate the continued need for treatment.
• The dose of Escitalopram should be increased as tolerated within the therapeutic dosage range in the smallest available increments at approximately 1- to 2-week intervals when prescribing shorter half-life SSRIs 1.

Potential Risks and Benefits

• The benefits of continued treatment with Escitalopram often outweigh the risks of stopping, particularly for patients with recurrent depression.
• However, patients should be aware of the potential risks, including QT prolongation, discontinuation syndrome, and increased risk of suicidal thinking or behavior.
• Healthcare providers should carefully monitor patients for these potential risks and adjust treatment accordingly 1.

Monitoring and Discontinuation

• Regular monitoring by a healthcare provider is essential during long-term use to assess ongoing benefit and manage side effects.
• Any discontinuation of Escitalopram should be done gradually by tapering the dose over weeks to months under medical supervision to minimize the risk of discontinuation syndrome 1.

From the Research

Effects of Long-Term Use of Escitalopram

• The long-term use of escitalopram has been studied in several clinical trials, with results indicating its safety and efficacy in the treatment of major depressive disorder (MDD) and anxiety disorders 2, 3, 4, 5, 6.
• A 12-month open-label study found that escitalopram demonstrated a favorable safety and tolerability profile, with further improvement in patient response 2.
• The most common adverse events associated with long-term escitalopram use were headache, back pain, upper respiratory tract infection, rhinitis, and nausea, with an incidence ranging from 11% to 17% 2.
• No new types of adverse events were seen after the acute period of 8 weeks, and the incidence of adverse events declined with time 2.
• Escitalopram has been shown to reduce the risk of recurrence of depression in patients with MDD, with a significant difference in time to recurrence compared to placebo 4.
• Long-term escitalopram treatment has also been found to be effective in the treatment of generalized anxiety disorder (GAD), with continuing improvement on anxiety and quality-of-life scores 6.

Safety and Tolerability

• The safety and tolerability of escitalopram have been evaluated in several studies, with results indicating that it is well tolerated in short- and long-term treatment 3, 5.
• Nausea was the only adverse event with an incidence greater than or equal to 10% and 5 percentage points greater than with placebo during short-term treatment 5.
• Adverse events related to sexual dysfunction were similarly frequent with escitalopram and citalopram, but were higher with paroxetine 5.
• No clinically relevant changes in clinical laboratory values were observed in patients treated with escitalopram, and the incidence of cardiovascular events was similar to that with placebo 5.

Efficacy

• Escitalopram has been shown to be effective in the treatment of MDD, with significant improvements in standard measurements of antidepressant effect 2, 3, 4.
• The drug has also been found to be effective in the treatment of GAD, with continuing improvement on anxiety and quality-of-life scores 6.
• Escitalopram has been shown to reduce the risk of recurrence of depression in patients with MDD, with a significant difference in time to recurrence compared to placebo 4.