Posted by dr dave on August 31, 2002, at 12:53:17
In reply to Dr. Dave versus Dr. Jack » dr dave, posted by Anyuser on August 31, 2002, at 11:33:31
Let me try to clarify - I am not trying to make a case against escitalopram. I am making a case against the claims that it is any different from citalopram. I think they are effectively identical.
When reading a study you need to understand who's writing it, and look at the actual results. The Gorman et al study was co-authored by two Forest employees, one of whom is a medical writer. It is not surprising it is enthusiastic in its tone. If you were to read an advertisement for a product in a magazine saying it was much much better than other similar products, would you automatically camp outside a store for it, or would you want to know more about whether those claims were justified?
To see whether the claims are justified, we look at the figures. It seems clear, from the figures which I have given in a previous posting, that there is no significant difference in side-effects. Indeed new research presented this week (Raines et al) looking at people switching from citalopram to escitalopram did not show any significant reduction in side-effects.
This leaves the issue of efficacy. Gorman's study shows no significant difference between citalopram and escitalopram at end-point when drop-outs are accounted for (LOCF analysis). While a significant response after one week is reported, this has been previously reported and used as a selling point for citalopram.
I quote the Gorman study (and other studies) because this debate should be about the scientific evidence that is avilable. The important thing is the truth, and I believe that lies more in the research data than in the opinions of those aiming to promote the drug.
Material produced by drug companies needs to be carefully analysed because (and excuse me if you find this shocking or hard to believe) it can sometimes be a little biased.
> I am surprised that someone eager to make a case against escitalopram keeps pressing the Gorman study. If you're depressed and considering Lexapro and you read the Gorman study, you will camp out on the sidewalk of your drugstore to be the first in line on the morning of the 5th. This is the first paragraph of Gorman's conclusion:
>
> "The results of the pooled analyses clearly support the previously reported antidepressant effect of escitalopram. Additionally, these findings suggest that escitalopram may be superior to citalopram, in terms of both speed of onset and magnitude of its clinical effects. The early and sustained antidepressant efficacy observed with escitalopram was achieved with doses of 10-20 mg/day, which have reported to be very well tolerated."
poster:dr dave
thread:109458
URL: http://www.dr-bob.org/babble/20020829/msgs/118350.html