Bupropion and Escitalopram Provide Similar Relief in Depressed Patients

Paula Moyer, MA

October 28, 2005

Oct. 28, 2005 (Amsterdam) — Patients get equivalent relief from depression with extended-release bupropion (Wellbutrin) as they do with escitalopram (Lexapro), according to a team of investigators form the U.S. who presented their findings here at the 18th congress of the European College of Neuropsychopharmacology.

"The two drugs had equal rates of response and remission, as well as average change in the severity of patients' depression," said principal investigator R. Taylor Segraves, MD, PhD. "With the exception of escitalopram's negative impact on sexual function, both drugs were well tolerated." Dr. Segraves is the chair of psychiatry at MetroHealth Medical Center in Cleveland, Ohio.

Sexual adverse effects are common among all selective serotonin reuptake inhibitors (SSRIs); the rates of sexual adverse effects with escitalopram are typical of other SSRIs, around 10% to 30%, according to previous research. Historically, bupropion has had no more effect on sexual function than placebo.

The investigators conducted the study to compare the efficacy of the antidepressants, which function by different mechanisms of action. Bupropion is a dual-action norepinephrine and dopamine reuptake inhibitor (NDRI) and escitalopram is an SSRI.

A total of 424 outpatients with moderate to severe major depressive disorder (MDD) were enrolled in an eight-week, double-blind, placebo-controlled study. The investigators randomized the patients to one of three treatment groups: extended-release bupropion at 300 to 450 mg daily, escitalopram at 10 to 20 mg daily, or placebo. The patients were randomized equally among the treatment groups. The investigators evaluated the efficacy on weekly or biweekly bases with both investigator- and subject-rated instruments, including the Hamilton Depression Rating Scale-17 (HAM-D-17).
In the bupropion group, the average dose for the 138 patients was 323 mg daily. The escitalopram group's average daily dose was 13 mg daily for the 149 patients. The two treatments demonstrated comparable efficacy. The change from the baseline HAM-D-17 score by study's end differed by 0.94 between the two active treatment groups. Compared with placebo, the average HAM-D-17 score reduction for the escitalopram group was significantly superior to placebo (P = .05); however, the reduction was not statistically significant in the bupropion group.

However, in the subject-completed Hospital Anxiety and Depression Scale, the total score improved similarly from baseline for both groups compared with placebo (average point reduction, 11.0 for the bupropion group vs 11.5 for the escitalopram group). Both treatments achieved results that were statistically significantly superior to placebo (P = .015 for bupropion and P = .003 for escitalopram).
The study was funded by GlaxoSmithKline, the maker of Wellbutrin.

ECNP 18th Congress: Abstract P.2.021. Presented Oct. 25, 2005.
European Neuropsychopharmacol. 2005;15(suppl 3):S453

Reviewed by Gary D. Vogin, MD