22 In the study by Burke et al,15 escitalopram 10 and 20 mg/day and the racemic form citalopram 40 mg/day were more effective than placebo on selleck inhibitor change on the HAMD 24 items and MADRS total score at the end of 8

weeks. There was no statistical Alvespimycin analysis between the two doses of escitalopram, but visual inspection of the figures in the publication15 does not suggest such a difference. Differences in response rate between each of the escitalopram dosage groups (50% and 51.2% for 10 and 20 mg/day, respectively) and the racemic Inhibitors,research,lifescience,medical form citalopram group (45.6%) were not significant, but the response rates were significantly Inhibitors,research,lifescience,medical greater for each group of active substance compared with the 27.7% response on placebo, with LOCF analysis in the MADRS. According to Bech et al,22 who reexamine this study using another psychometric approach,10 when all included patients were analyzed, no dose-response relationship was seen. However, in the 212 severely depressed patients (MADRS total score ≥30), a positive dose-response relationship for escitalopram Inhibitors,research,lifescience,medical was seen on MADRS and the two subscales (HAMD6, MADRS6) after 6 and 8 weeks of therapy At the end of

8 weeks, the effects sizes, analyzed on ITT-LOCF, were around 0.34 on the subscales and 0.32 on MADRS for escitalopram 10 mg/day, around 0.73 on Inhibitors,research,lifescience,medical the subscales and 0.71 on MADRS for escitalopram 20 mg/day, and around 0.46 on the subscales and 0.37 on MADRS for racemic form of citalopram 40 mg/day Only escitalopram 20 mg/day and the racemic form of citalopram 40 mg/day were superior to placebo. However, the confidence intervals indicated that the differences were not significant. Fluoxetine The studies with fluoxetine did not show significant differences in terms

Inhibitors,research,lifescience,medical of clinical efficacy across a dose range of 20 to 60 mg/day Even a dose of 5 mg/day was effective compared with placebo (Table I) 1 Therefore, for the majority Drug_discovery of patients, there is no advantage of increasing the dose of fluoxetine above 20 mg/day. It might even be the case that the higher dose of 60 mg/day is less effective in major depressive disorder.23 In the first study by Wernicke et al (Table I), 20 doses of fluoxetine 20 and 40 mg/day, but not 60 mg/day, were more effective than placebo on change on the HAMD total score on ITT-LOCF at the end of 6 weeks. Fluoxetine 20 and 40 mg/day were statistically superior to 60 mg/day. No statistical comparison was performed between fluoxetine 20 and 40 mg/day, but visual inspection of the data in the publication16 suggests that there was no such difference.