From the Guidelines
Escitalopram is generally considered to have a more favorable side effect profile compared to sertraline, with potentially less sexual dysfunction and less impact on energy levels, making it a preferable choice for patients with depression and anxiety disorders. When considering the treatment of depressive disorders, both escitalopram and sertraline are effective selective serotonin reuptake inhibitors (SSRIs) [ 1 ].
Key Differences
- Escitalopram is typically dosed at 10-20mg once daily, while sertraline is usually dosed at 50-200mg once daily.
- Sertraline may be preferred for patients with comorbid conditions like OCD or PTSD, as it has specific FDA approvals for these conditions.
- Both medications take 4-6 weeks for full therapeutic effect and should be started at lower doses (escitalopram 10mg, sertraline 50mg) and titrated as needed [ 1 ].
Quality of Life and Effectiveness
- Evidence from 18 fair-quality efficacy trials showed no differences among second-generation antidepressants, including escitalopram and sertraline, in terms of quality of life or functional capacity [ 1 ].
- The reviewers gathered evidence from 3 studies that evaluated effectiveness of different SSRIs and found no significant differences among them for the treatment of MDD [ 1 ].
Considerations for Treatment
- The choice between escitalopram and sertraline should consider the patient's specific symptoms, comorbidities, prior response to SSRIs, and potential drug interactions [ 1 ].
- Escitalopram is metabolized primarily through CYP3A4, while sertraline involves multiple pathways including CYP2D6.
From the Research
Comparison of Escitalopram and Sertraline
- Escitalopram is the S-enantiomer of the selective serotonin reuptake inhibitor (SSRI) citalopram, which contains equal amounts of the S- and R-forms in a racemic mixture 2.
- SSRIs, including escitalopram and sertraline, share many similarities, but differ in terms of pharmacokinetics and effects on CYP450 enzymes 3.
- The highly specific mechanism of action of SSRIs confers advantages on this group, relative to other classes of antidepressant, including a greatly reduced risk of toxicity in overdose and improved tolerability 4.
Efficacy and Tolerability
- Escitalopram is at least as effective in the treatment of depression and anxiety as other SSRIs, including sertraline, as well as venlafaxine, bupropion, and duloxetine 2.
- SSRIs, including escitalopram and sertraline, have a low incidence of anticholinergic effects and are essentially devoid of cardiotoxicity 4.
- Higher doses of SSRIs, but not SNRIs, are associated with significantly greater symptom improvement and likelihood of treatment response, but also with an increased likelihood of dropout due to side effects 5.
Differences Between SSRIs
- Despite a lack of sedative effect, SSRIs are more effective than TCAs in the treatment of depression with anxiety 4.
- The structural diversity of SSRIs is reflected in emerging qualitative and quantitative differences in side effects and drug interaction potential 4.
- Significant differences in the potential for drug interactions among SSRIs are related to their relative potency for inhibition of important liver drug-metabolising enzymes 4.
- There are no significant differences in efficacy between pharmacological agents within the SSRI class, including escitalopram and sertraline 5.