A comparative review of escitalopram, paroxetine, and sertraline: Are they all alike?
Article Details
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Sanchez C, Reines EH, Montgomery SA
A comparative review of escitalopram, paroxetine, and sertraline: Are they all alike?
Int Clin Psychopharmacol. 2014 Jul;29(4):185-96. doi: 10.1097/YIC.0000000000000023.
- PubMed ID
- 24424469 [ View in PubMed]
- Abstract
It is known that newer antidepressants, such as the selective serotonin reuptake inhibitors (SSRIs), provide advantages in tolerability over antidepressants such as the tricyclics. However, even within the SSRI class, differences in efficacy or tolerability exist between the individual drugs. Among the three most widely prescribed SSRIs are paroxetine, sertraline, and escitalopram. Escitalopram is commonly referred to as an SSRI, but also has well-documented allosteric properties, and thus can be further classed as an allosteric serotonin reuptake inhibitor. All three antidepressants are efficacious compared with placebo, but there is evidence that escitalopram is more effective than a range of other antidepressants. There are no direct data to regard either paroxetine or sertraline as a superior antidepressant. Escitalopram is superior compared with paroxetine, which has a less favorable tolerability profile. Paroxetine is associated with cholinergic muscarinic antagonism and potent inhibition of CYP2D6, and sertraline has moderate drug interaction issues in comparison with escitalopram. Overall, as an allosteric serotonin reuptake inhibitor that is somewhat different from classical SSRIs, escitalopram is the first choice judged by combined efficacy and tolerability, and nonclinical data have offered possible mechanisms through which escitalopram could be more efficacious, based on its interaction with orthosteric and allosteric binding sites at the serotonin transporter.
DrugBank Data that Cites this Article
- Drugs
- Drug Targets
Drug Target Kind Organism Pharmacological Action Actions Escitalopram 5-hydroxytryptamine receptor 1A Protein Humans UnknownInhibitorDetails Escitalopram 5-hydroxytryptamine receptor 2A Protein Humans UnknownInhibitorDetails Escitalopram 5-hydroxytryptamine receptor 2C Protein Humans UnknownInhibitorDetails Escitalopram Alpha-1 adrenergic receptors (Protein Group) Protein group Humans UnknownInhibitorDetails Escitalopram Alpha-2 adrenergic receptors (Protein Group) Protein group Humans UnknownInhibitorDetails Escitalopram Dopamine D2 receptor Protein Humans UnknownInhibitorDetails Escitalopram Histamine H1 receptor Protein Humans UnknownInhibitorDetails Escitalopram Muscarinic acetylcholine receptor M1 Protein Humans UnknownInhibitorDetails Escitalopram Sodium-dependent dopamine transporter Protein Humans NoInhibitorDetails Escitalopram Sodium-dependent noradrenaline transporter Protein Humans UnknownInhibitorDetails Escitalopram Sodium-dependent serotonin transporter Protein Humans YesInhibitorDetails