Lexapro

The newest weapon in the war against depression, lexapro comes with high hopes and expectations, and even higher promises. But is it truly the wonder drug that some claim it to be?

A few facts about lexapro:

• Lexapro (escitalopram) was approved by the FDA for treatment of major depressive disorder in August of 2002.

• Lexapro belongs to the group of antidepressants called selective serotonin reuptake inhibitors, or SSRI's.

• Like prozac, paxil and celexa, lexapro blocks the reabsorption of serotonin by neurotransmitters in the brain.

• Lexapro is marketed by Forest Laboratories, the same company that sells celexa. Forest was a small drug manufacturer before celexa, but now is a major player in the extremely lucrative antidepressant marketplace.

• Both celexa and lexapro were developed by the Danish company H Lundbeck A/S. Lundbeck already sells escitalopram (lexapro) under the brand name cipralex in many European countries.

• There are other viable alternatives to lexapro.

The well-funded and highly organized marketing campaign for lexapro here in the United States centers upon the following three claims:

1. Lexapro is more potent than celexa.

Let's take a closer look.

A molecule of citalopram (celexa) is actually made up of two mirror-image molecules, the S-enantiomer and the R-enantiomer.

An enantiomer is either one of a pair of compounds that are mirror images of each other, but not identical - a type of isomer.

Scientists have successfully split the two isomers of the celexa molecule in half to create the lexapro molecule.

Lexapro is the 'left-hand' side, or S-enantiomer of celexa. In other words, lexapro is one-half of the celexa molecule.

This 'left-hand' side of the celexa molecule presumably is the 'active' part, while the 'right-hand' side, the R-enantiomer, is theorized to contain no depression-fighting ability and may contribute to side effects.

If this theory is true, then lexapro may indeed be more potent than celexa, in the sense that 1000mg of Vitamin C is more potent than 500mg of Vitamin C (since the 500mg tablet would have more 'filler').

Perhaps a more accurate statement would be to say that lexapro is a more concentrated version of celexa.

2. Lexapro has fewer side effects than celexa.

Dr. William Burke headed the research trials comparing lexapro 10 mg, lexapro 20 mg, celexa 40 mg, and placebo.

The total side effects reported were:

70.5% for placebo,

79.0% for lexapro 10 mg,

85.6% for lexapro 20 mg, and

86.4% for celexa 40 mg.

The drop-out rate due to adverse side effects were:

2.5% for placebo,

4.2% for lexapro 10 mg,

10.4% for lexapro 20 mg, and

8.8% for celexa 40 mg.

So yes, technically the side effects profile of lexapro is slightly less than that of celexa, but not by much. The differences are considered statistically insignificant.

Also, note the higher drop-out rate for lexapro at the 20 mg dose when compared to the standard celexa dose of 40 mg.

(By comparison, the drop-out rates for paxil and effexor were 20% and 19%, much higher than lexapro or celexa.)

3. Lexapro produces quicker results than celexa - sometimes within one or two weeks.

(You may remember the same fast-acting claims were made for celexa when it first came out four years ago, which later turned out to be less than genuine.)

Some lexapro users did notice a reduction in depression symptoms in a week or so. However, this could easily be attributed to the 'placebo effect' rather than the drug itself.

A common practice in clinical drug trials for testing new antidepressants is to first give all particpants a placebo. Those who show rapid improvement are removed from the study.

This typically amounts to half the patients! So, while the claim of rapid improvement may be accurate, it's not the complete story.

We so desperately want to believe there will be a medical cure for depression, anxiety, and all the other emotions that cause us so much pain.

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The pain is real and sometimes all-encompassing. But things can change, and they can change right now.

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