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      A 12-week Comparative Prospective Open-label Randomized Controlled Study in Depression Patients Treated with Vilazodone and Escitalopram in a Tertiary Care Hospital in North India

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          Abstract

          Background:

          Depression is a leading cause of morbidity in modern world and introduction of selective serotonin reuptake inhibitors (SSRIs) was a revolution for treating depression. However, sexual dysfunction and weight gain always remained an issue for patients leading to discontinuation of treatment. Vilazodone is a novel SSRI and literature show better efficacy and decrease weight gain and sexual dysfunction.

          Aim of study:

          This study aims to compare the efficacy, sexual dysfunction, and weight gain caused due to vilazodone and escitalopram.

          Methodology:

          This is an open-label randomized, controlled study; 60 patients diagnosed as depression were divided into two groups of 30 each. One group was started on vilazodone and one on escitalopram randomly. The groups were compared on the basis of efficacy, weight gain, and sexual dysfunction by applying Hamilton Depression Rating Scale (HDRS) and Arizona Sexual Experience Scale (ASEX) at baseline, 4, and 12 weeks interval. Statistical analysis was done by applying Chi-square, t-test, and fisher exact test and descriptive analysis.

          Results:

          Vilazodone group shows fall in HDRS with 18.77 ± 4.3, 14.83 ± 3.68, and 9.63 ± 3.06 while it was 18.8 ± 4.09, 14.3 ± 2.96, and 8.43 ± 2.1 at baseline, 4, and 12 weeks, respectively. ASEX score in vilazodone was found to have 16.87 ± 2.97, 15.37 ± 3.1, and 11.73 ± 3.55 while on escitalopram, 16.4 ± 3.35, 17.13 ± 3.48, and 18.37 ± 4.09 at first visit, 4, and 12 weeks, respectively. Patients on vilazodone had mean weight of 69.63 ± 7.7, 69.83 ± 7.83, and 69.9 ± 7.69 while on escitalopram, 72.47 ± 7.95, 72.87 ± 7.9, and 75.6 ± 8.46 at baseline, 4, and 12 weeks, respectively.

          Conclusions:

          Our study shows that vilazodone has better efficacy, lesser weight gain, and lesser sexual dysfunction.

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          Most cited references11

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          The Arizona Sexual Experience Scale (ASEX): reliability and validity.

          Although sexual dysfunction is common in psychiatric patients, quantification of sexual dysfunction is limited by the paucity of validated, user-friendly scales. In order to address this problem, the authors have developed the Arizona Sexual Experiences Scale (ASEX), a five-item rating scale that quantifies sex drive, arousal, vaginal lubrication/penile erection, ability to reach orgasm, and satisfaction from orgasm. Possible total scores range from 5 to 30, with the higher scores indicating more sexual dysfunction. This study assesses the internal consistency, test-retest reliability, and convergent and discriminant validity of the ASEX.
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            Weight gain and antidepressants.

            M. FAVA (2000)
            Weight gain during antidepressant treatment can be either a sign of improvement in patients who have weight loss as a symptom of depression or a residual symptom in patients who overeat when depressed. However, significant weight gain during the acute phase of treatment or weight gain that continues despite achieving full remission of depressive symptoms is likely to be a side effect of antidepressant treatment. Weight gain is a relatively common problem during both acute and long-term treatment with antidepressants, and it is an important contributing factor to noncompliance. This article will review the literature with regard to the relative risk for weight gain of antidepressants. It appears that tricyclic antidepressants (TCAs) and perhaps monoamine oxidase inhibitors (MAOIs) may be more likely to cause weight gain than the selective serotonin reuptake inhibitors (SSRIs) or the newer antidepressants, with the exception of mirtazapine, which may be placed between the SSRIs and the TCAs in terms of relative risk for weight gain. Paroxetine may be more likely to cause weight gain than the other SSRIs during long-term treatment, and bupropion and nefazodone may be less likely to cause weight gain than the SSRIs in the long term, although more studies are necessary to confirm these impressions.
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              Tolerability of modern antidepressants.

              Antidepressant side effects may have implications with regard to patient safety as well as the overall tolerability of treatment. Side effects relevant to patient safety can contribute to an increased risk of morbidity and mortality, but may or may not result in patient distress or discomfort. In contrast, side effects related to tolerability can contribute to patient discomfort but are not associated with an immediate increase in risk of morbidity or mortality. Common tolerability-related side effects of modern antidepressants include nausea, insomnia, somnolence, fatigue, sexual dysfunction, and weight gain. Because these side effects can result in patient discomfort and distress, they can lead to poor compliance or noncompliance with treatment that, in turn, may result in an increased risk of depressive relapse or recurrence. Modern antidepressants have varying tolerability profiles, and clinicians should be vigilant about balancing treatment efficacy with side effects when choosing antidepressants. This article compares the rates of common tolerability-related side effects among the newer (post-tricyclic era) antidepressants with the selective serotonin reuptake inhibitors, the most popular contemporary first-line treatment for depression.
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                Author and article information

                Journal
                Indian J Psychol Med
                Indian J Psychol Med
                IJPsyM
                Indian Journal of Psychological Medicine
                Medknow Publications & Media Pvt Ltd (India )
                0253-7176
                0975-1564
                Jan-Feb 2018
                : 40
                : 1
                : 80-85
                Affiliations
                [1]Department of Psychiatry, MM Institute of Medical Sciences and Research, Ambala, Haryana, India
                Author notes
                Address for correspondence: Dr. Shazia Anjum 152, Inside Sirhindi Gate, Sangrur, Malerkotla - 148 023, Punjab, India. E-mail: shaziaaamir55@ 123456gmail.com
                Article
                IJPsyM-40-80
                10.4103/IJPSYM.IJPSYM_368_17
                5795684
                29403135
                7bb5a488-7e58-4bfb-a6dc-ab86a9d91da8
                Copyright: © 2018 Indian Psychiatric Society - South Zonal Branch

                This is an open access article distributed under the terms of the Creative Commons Attribution-NonCommercial-ShareAlike 3.0 License, which allows others to remix, tweak, and build upon the work non-commercially, as long as the author is credited and the new creations are licensed under the identical terms.

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                Categories
                Original Article

                Clinical Psychology & Psychiatry
                escitalopram,sexual dysfunction,vilazodone,weight gain
                Clinical Psychology & Psychiatry
                escitalopram, sexual dysfunction, vilazodone, weight gain

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