Akademik Veri Yönetim Sistemi
Klinik Psikofarmakoloji Bulteni, cilt.21, sa.3, ss.210-218, 2011 (SCI-Expanded)
Objective: In the treatment of major depressive disorder, in addition to the remission of symptoms, improvement in functionality and subjective quality of life of the patients is desirable. In this study, we aimed to evaluate and compare the changes in quality of life measures in citalopram- versus escitalopram-treated major depressive disorder patients, and to compare the scores of the patients who achieved remission at the end of treatment with standard scores of the Turkish population. Methods: The study was carried out in 74 outpatients with major depressive disorder. The mean age was 40.6 in the citalopram group and 24 (63.5%) of them were female. In the escitalopram group, the mean age was 38.6 and 62.2% of the group were female. Duration of illness was 3.19 years in the citalopram group and 3.49 years in escitalopram group. In the citalopram group 54.1% of the patients experienced single episodes, while 81.1% of the escitalopram group had single episodes. To assess the severity of depression, the Hamilton Depression Rating Scale (HAM-D) was utilized. For the assessment of quality of life, Short Form-36 (SF-36) and EuroQol-5D (EQ-5D) were used. Patients were randomized to either citalopram or escitalopram for the treatment and evaluated at the 2nd, 4th and 6th weeks. Citalopram was started at a dose of 20 mg/day, and escitalopram was started at a dose of 10 mg/day. Treatment response was accepted as a 50% decrease in the index assessment and remission was accepted as HAM-D≤7. After the 2nd week, in patients without a decrease of more than 25% in HAM-D scores as a treatment response, the medication dose was raised by 50%. In the statistical analyses, the T Test was performed for groups with normal distribution, whereas for groups without normal distribution, the Mann-Whitney U Test was performed. In addition for the assessment of change in the parameters, Cohen's d Test was calculated for effect size. Results: At the end of the 6th week, the mean dose for the citalopram treated patients was 24.6 mg/day and for the escitalopram treated patients it was 11.8 mg/day. All patients responded and the remission rate (HAM-D≤7) was 63.5%. There was no statistical difference between the treatment groups in terms of response and remission. In the quality of life measures, all domain scores of both SF-36 and EQ-5D were found to improve significantly starting at the 4th week. The two treatment groups did not differ in terms of quality of life variables, but in the 2nd week in the escitalopram group more parameters of quality of life were found to be improved. At the end of the 6th week, even though the patients had significantly increased scores, the effect size for all parameters was moderate. Patients who reached remission in both treatment groups (n=53) still had lower scores in the domains of SF-36 such as general health perception, social functioning, and emotional role difficulties compared to the standard values of Turkish population. Patients with recurrent episodes had more impairment at the end of the acute treatment. Conclusions: There was no significant difference between citalopram and escitalopram regarding the decrease in quality of life scores. While the scores of quality of life and functioning measures increased significantly, normalization was not obtained in either group in terms of quality of life.