Rising Escitalopram Use in British Columbia: Is it Rational and Evidence-Informed?

Abstract

Plain Language Summary Title

Citalopram vs. Escitalopram for major depression: No Real Difference in Efficacy or Safety, Just Higher Cost.

Plain Language Summary

Background:

Citalopram is an antidepressant. Escitalopram is a closely related drug—basically a slightly modified version of citalopram—that drug companies promote as being safer, more effective, and faster acting. In Canada, escitalopram costs about twice as much as citalopram. We wanted to know how these two drugs are actually used in British Columbia and whether escitalopram really works better or is any safer.

What We Did:

We looked at prescription records for the nine most common antidepressants in BC between 2005 and 2024. We also reviewed all the studies that directly compared citalopram with escitalopram. We focused on whether any differences were large enough to matter to patients, whether study results were reliable, and whether studies had problems such as bias or conflicts of interest.

What We Found:

By 2013, escitalopram had become the most prescribed antidepressant in BC, while citalopram use dropped. We found 16 studies that compared the two drugs. Many had problems such as missing data, selective reporting, or funding from the drug manufacturer. None of the studies showed meaningful differences in effectiveness. Claims that escitalopram works faster were weak and inconsistent. Side effects were essentially the same, including risks for heart rhythm changes (QT prolongation).