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Lexapro maintains status as first-line antidepressant therapy

Posted Jun 24 2008 5:07pm

Lexapro_vs_pristiqAccording to a Decision Resources (DR) press release,Lexapro (escitalopram), a SSRI, "retains leadership among first-line therapies in the treatment of major depression"despite the fact that physicians have increasingly moved toward the use of SNRIs, eg, Effexor (venlafaxine). However, the reason why SSRIs still retain their first-line status is due to

  • cost
  • efficacy
  • familiarity

SSRIs have been out on the market for much longer than SNRIs so it's what physicians are more comfortable with. As far as I know, there currently aren't any generic SNRIs in the U.S.

As a result, SNRIs are likely pricier.

DR's survey of psychiatrists found that the majority believe SNRIs work better in treating clinical depression than SSRIs and about 44 percent believe they have fewer sexual side effects. PCPs were also included in this survey and it seems that the majority of them believed the opposite despite DR's spin that a lot of PCPs are on board with psychiatrists. From personal experience, four SSRIs were prescribed to me before I was shifted to a SNRI.

In the up-and-coming SNRI department, DR forecasts a bright future for Pristiq (desvenlafaxine).

Physicians are expected to move patients from Effexor to Pristiq-a newly approved SNRI- over the next two years. ... Pristiq will begin to replace Wyeth's Effexor XR and Lilly's Cymbalta, especially in psychiatrists' practices.

This is an interesting analysis from DR considering thatpsychiatrists, health insurers, and even some investors seem less than impressed with the slight advantages the "me-too" drug has over Effexor.

(logos fromForest Pharmaceuticals, Inc.andWyeth)

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