Comparative Efficacy of Escitalopram Versus Other Antidepressants in Adults With Major Depressive Disorder: A Meta-Analysis of Randomized Controlled Trials

Objective: To assess if escitalopram exhibits greater efficacy in attaining clinical response or remission in adult patients with major depressive disorder (MDD) compared to other frequently prescribed antidepressants, utilising binary outcomes from randomised controlled trials. Methods: A meta-analysis were performed in accordance with Preferred Reporting Items for Systematic Reviews and Meta-Analyses (PRISMA) 2020 recommendations. Databases such as PubMed, Scopus, Cochrane Library, and Google Scholar were queried for randomised controlled trials (RCTs) and meta-analyses that compared escitalopram with alternative antidepressants in individuals diagnosed with major depressive disorder (MDD). Studies were considered if they presented binary outcomes (response/remission) and/or facilitating the calculation of odds ratios (ORs). A fixed-effect meta-analysis was conducted utilising log-transformed odds ratios (ORs) and confidence interval (CI). Results: Five qualifying studies were included. Escitalopram showed statistically significant superiority compared to comparators, including duloxetine, paroxetine, sertraline, venlafaxine, fluoxetine, and citalopram. The pooled odds ratio for attaining clinical response or remission was 1.32 (95% confidence interval [CI]: 1.21–1.43), signifying a 32% increased probability of positive outcomes with escitalopram. The forest plot validated consistency among research, with Montgomery et al. (2011) and Wade et al. (2007) demonstrating notably robust results. Conclusion: Escitalopram seems to be more efficacious than other antidepressants in eliciting response and remission in individuals with Major Depressive Disorder (MDD). This study advocates for its preferential application as a first-line pharmacological drug; however, individual patient considerations should inform ultimate treatment choices.