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 Table of Contents 
ORIGINAL ARTICLE
Year : 2022  |  Volume : 13  |  Issue : 1  |  Page : 80-84  

Improvement in quality of life of postmenopausal women with depression with commonly used antidepressants (Escitalopram vs. Desvenlafaxine): A randomized controlled trial in a tertiary care teaching hospital of North India


1 Department of Pharmacology, Government Medical College, Jammu, Jammu and Kashmir; Department of Pharmacology, Government Medical College Medical College and Hospital, Sec-32, Chandigarh, India
2 Department of Psychiatry, Psychiatry Diseases Hospital, Jammu, Jammu and Kashmir, India
3 Department of Pharmacology, Government Medical College, Jammu, Jammu and Kashmir, India
4 Department of Internal Medicine, Government Medical College, Jammu, Jammu and Kashmir, India

Date of Submission27-Aug-2021
Date of Decision03-Dec-2021
Date of Acceptance21-Jan-2022
Date of Web Publication2-May-2022

Correspondence Address:
Sonia Shinde Mahajan
Department of Pharmacology, Govt. Medical College and Hospital, Sec 32, Chandigarh - 160 047
India
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Source of Support: None, Conflict of Interest: None


DOI: 10.4103/jmh.jmh_150_21

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   Abstract 


Introduction: The postmenopausal symptoms affect the quality of life (QoL) of women. Depression and anxiety too have been associated with diminished QoL. It is known that antidepressants escitalopram and desvenlafaxine are effective in the treatment of depression and anxiety. However, to the best of our knowledge, their comparative effect on the QoL of postmenopausal women with depression and anxiety has not been studied in the Indian setup. Materials and Methods: The present study was a randomized, intention to treat, open-label trial undertaken in North India's a tertiary care teaching hospital. Postmenopausal women attending the psychiatry outpatient department and newly diagnosed with depression and anxiety were randomized in two groups to receive Tab. Escitalopram 10–20 mg and Tab. Desvenlafaxine 50–100 mg. Their QoL was assessed using the WHOQOL BREF scale at baseline, 3 weeks and 6 weeks. Results: Escitalopram was observed to be statistically better than desvenlafaxine in improving the overall QoL score of the WHOQOL-BREF scale. Individually, escitalopram significantly improved the scores of the physical health domain, psychological and environmental domains except for the social relationship domain. Desvenlafaxine significantly improved scores of all four domains. Conclusion: Escitalopram was observed to be significantly better than desvenlafaxine in improving the overall QoL scores. Both the drugs were well tolerated.

Keywords: Anxiety, depression, desvenlafaxine, escitalopram, postmenopausal women, quality of life


How to cite this article:
Mahajan SS, Arora M, Tandon VR, Mahajan A, Kotwal S. Improvement in quality of life of postmenopausal women with depression with commonly used antidepressants (Escitalopram vs. Desvenlafaxine): A randomized controlled trial in a tertiary care teaching hospital of North India. J Mid-life Health 2022;13:80-4

How to cite this URL:
Mahajan SS, Arora M, Tandon VR, Mahajan A, Kotwal S. Improvement in quality of life of postmenopausal women with depression with commonly used antidepressants (Escitalopram vs. Desvenlafaxine): A randomized controlled trial in a tertiary care teaching hospital of North India. J Mid-life Health [serial online] 2022 [cited 2022 May 18];13:80-4. Available from: https://www.jmidlifehealth.org/text.asp?2022/13/1/80/344562




   Introduction Top


Postmenopausal symptoms affect the work, mood, concentration, energy levels, and social and sexual activity of the women. The quality of life (QoL), indicative of a person's perception and level of satisfaction with daily activities, of women suffering from severe symptoms is compromised if they do not take any treatment for the same.

Depression has also been associated with diminished functional impairment as well as diminished QoL.[1],[2] It is known to hamper the QoL by having a negative effect on physical, mental, and social well-being.[3] Functional impairment can intensify psychological problems and may also persist even after symptom remission. Therefore, its restoration to predepression levels is as important as symptom amelioration.

Selective serotonin reuptake inhibitors and, most importantly, escitalopram are the well-established drugs of the first choice for depression and anxiety disorders.[4],[5] Moreover, escitalopram was also observed to be effective in treating depression and anxiety in comparison to desvenlafaxine, in postmenopausal women, after a minimum of 6 weeks of treatment.[6]

As described earlier, depression has an adverse impact on the QoL and the functioning of postmenopausal women. Hence, in the present study, an attempt was made to study the effect of both drugs on the QoL of such women. To study the QoL, the WHOQOL-BREF scale was used. It is a short form of the original WHOQOL-100 scale. It allows domain-wise QoL assessment. WHOQOL-BREF has four basic domains, namely physical health, psychological, social relationships, and environment and two additional items of overall QoL and general health. The scores of each domain depict the patient's perception of QoL in each particular domain.[7]

Individually, both escitalopram and desvenlafaxine have been reported to be efficacious in improving the QoL of adult patients suffering from depression and anxiety.[2],[8] However, to the best of our knowledge, we could not find any Indian study doing a head-to-head comparison of the effectiveness of these in improving the QoL in postmenopausal women with depression and anxiety. Therefore, a comparative evaluation of the efficacy of escitalopram versus desvenlafaxine on QoL in postmenopausal women with depression and anxiety was done.


   Materials and Methods Top


The present study was a randomized, intention to treat, open-label trial undertaken in North India's tertiary care teaching hospital over a period of 6 months. It was initiated after prior approval of the Institutional Ethics Committee.

Written informed consent was obtained from patients. Patients were assessed for eligibility after applying inclusion and exclusion criteria. All principles of bioethics were followed.

Inclusion criteria

  1. Postmenopausal women between 40 and 65 years of age with either natural or surgical menopause
  2. Attending psychiatry outpatient department
  3. Newly diagnosed with depression as per the Diagnostic and Statistical Manual-V criteria[9]
  4. Total score of ≥ 18 on the Hamilton Depression Rating Scale[10]
  5. Total score of ≥ 18 on the Hamilton Anxiety Rating Scale.[11]


Exclusion criteria

  1. Women with uncontrolled comorbidities
  2. Past history of major depression, bipolar disorder, and drug or alcohol abuse
  3. Taking any prior psychopharmacological agents
  4. On hormonal therapy
  5. Diagnosed with endometrial or ovarian cancer, myocardial infarction, angina pectoris, cerebrovascular event, stroke, and acute illness
  6. Having a history of intolerance or allergic reaction to the study drugs.


The included women were randomized to the two treatment arms in a ratio of 1:1 by the block permutation method. Women enrolled in Group 1 received flexible dose of tablet escitalopram 10–20 mg/day and those in Group 2 received tablet desvenlafaxine 50–100 mg/day.

The WHOQOL-BREF scale was used for the assessment of the QoL of these patients at the baseline visit, 3 weeks, and 6 weeks. It is a prevalidated and pretested scale with an internal consistency value of > 0.7. The scale showed good discriminant validity, content validity, and test–retest reliability.[7]

The values were recorded and compared at 0, 3, and 6 weeks. Paired and unpaired t-tests were used for intra and intergroup analysis at all follow-ups. P < 0.05 was considered to be statistically significant. All the patients were observed during the course of the study for adverse drug reactions.


   Results Top


The demographic profile of the study population is as mentioned in [Table 1]. Baseline scores of various domains of the WHOQOL-BREF scale of the participants were comparable in both groups.
Table 1: Demographic characteristics of patients

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The mean overall QoL values in escitalopram and desvenlafaxine groups are as shown in [Table 1]. Treatment with escitalopram produced statistically significant improvement in comparison to placebo at the 6-week follow-up (P = 0.008) [Table 2].
Table 2: Comparative effect of escitalopram versus desvenlafaxine on mean “overall quality of life” score in WHOQOL-BREF scale

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Moreover, both the drugs showed significant improvement in the overall health of these patients after 3 and 6 weeks of treatment (P < 0.001). However, on intergroup comparisons, both the drugs were found to be comparable to each other at both the follow-ups. Both escitalopram and desvenlafaxine showed a comparable effect on the mean transformed scores (0–100) of the physical health domain on intergroup analysis [Table 3]. As far as the psychological improvement of these women was concerned, both the drugs showed statistically significant results (P < 0.001) at both 3- and 6-week follow-up. However, no drug was found to be better than the other on head-to-head comparison [Table 4]. The effects of the two drugs on the social relationship and environment domains are shown in [Table 5] and [Table 6].
Table 3: Comparative effect of escitalopram versus desvenlafaxine on mean transformed score (0-100) of “Physical Health (Domain 1)” in WHOQOL-BREF scale

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Table 4: Comparative effect of escitalopram versus desvenlafaxine on mean transformed score (0-100) of “psychological domain (Domain 2)” in WHOQOL-BREF scale

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Table 5: Comparative effect of escitalopram versus desvenlafaxine on mean transformed score (0-100) of “social relationship (Domain 3)” in WHOQOL-BREF scale

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Table 6: Comparative effect of escitalopram versus desvenlafaxine on mean transformed score (0-100) of “environment (Domain 4)” of in WHOQOL-BREF scale

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The compliance of the patients was assessed by maintaining the pill count and by confirming the same from the family members in contact with the patients.

Gastritis was the most common adverse event observed in both groups. All the adverse events were mild in nature and did not require the withdrawal of treatment.


   Discussion Top


There is a substantial prevalence of depression, of about 42.47% of perimenopausal and postmenopausal women in India.[12] Furthermore, in the United States, about 20% of women experience depression during their postmenopausal period.[13]

In the present study, escitalopram was found to be statistically better than desvenlafaxine in improving overall QoL after 6 weeks of treatment. This finding could be attributed to the fact that escitalopram was observed to be effective in treating depression in postmenopausal women after 6 weeks of treatment.[6] Thus, it can be suggested that there is a correlation between the amelioration of depression and the improvement in QoL of depressed postmenopausal women.

However, the results of the present study differ from those of Soares et al., 2010, in which both the drugs were found to be comparable to each other in improving the QoL of postmenopausal women with depression and anxiety even after 6 months of therapy.[14] The difference in results could be due to different demographic profiles of the patient population, larger sample size, different study design and treatment regimen, longer duration of the study, and differences in the doses used.

Furthermore, in the present study, both escitalopram and desvenlafaxine were individually found to be effective in improving the QoL of these women. Various authors in the past have substantiated the respective efficacy of escitalopram in improving the QoL of patients in comparison to placebo or some other drugs.[15],[16],[17],[18] Similarly, in a study by Wang et al., 2018, escitalopram significantly improved the QoL as measured by the Quality of life Enjoyment and Satisfaction Questionnaire-Short Form (Q-LES-Q-SF) score after 2 weeks of treatment in postmenopausal women with depression and comorbid anxiety.[2] Furthermore, Endicott et al., 2014, observed that there was a statistically significant improvement from baseline in 10 of 16 Quality of Life Enjoyment and Satisfaction Questionnaire item scores in adult outpatients with major depressive disorder after 12 weeks of treatment with desvenlafaxine, as compared to placebo with P ≤ 0.044.[19]

In this study, escitalopram was individually effective in improving scores in psychological, physical, and environmental domains at both 3 weeks and 6 weeks. No improvement was seen in the social domain score even after 6 weeks of treatment. Similar findings were reported in a study by LaCroix et al., 2012, done in healthy postmenopausal women.[20]

However, there is a paucity of studies doing a domain-wise head-to-head comparison of both the drugs like our study.


   Conclusion Top


Thus, it was observed that escitalopram was more effective than desvenlafaxine in improving the overall QoL of postmenopausal women suffering from depression and anxiety after at least 6 weeks of treatment. Moreover, both the drugs appeared to be equally safe and well tolerated. Although the results of this study are promising, it is required to generate more evidence base by conducting large-scale randomized controlled trials before the findings can be put to clinical use.

Financial support and sponsorship

Nil.

Conflicts of interest

There are no conflicts of interest.



 
   References Top

1.
Papakostas GI, Petersen T, Mahal Y, Mischoulon D, Nierenberg AA, Fava M. Quality of life assessments in major depressive disorder: A review of the literature. Gen Hosp Psychiatry 2004;26:13-7.  Back to cited text no. 1
    
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Wang G, You X, Wang X, Xu X, Bai L, Xie J, et al. Safety and effectiveness of escitalopram in an 8-week open study in Chinese patients with depression and anxiety. Neuropsychiatr Dis Treat 2018;14:2087-97.  Back to cited text no. 2
    
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Coplan JD, Aaronson CJ, Panthangi V, Kim Y. Treating comorbid anxiety and depression: Psychosocial and pharmacological approaches. World J Psychiatry 2015;5:366-78.  Back to cited text no. 4
    
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Mahajan SS, Tandon VR, Arora M, Mahajan A, Kotwal S. Comparative efficacy and safety of escitalopram versus desvenlafaxine in postmenopausal women with depression and anxiety: A randomized, open-label, comparative trial. J Midlife Health 2019;10:141-6.  Back to cited text no. 6
    
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Misri S, Swift E, Abizadeh J, Shankar R. Overcoming functional impairment in postpartum depressed or anxious women: A pilot trial of desvenlafaxine with flexible dosing. Ther Adv Psychopharmacol 2016;6:269-76.  Back to cited text no. 8
    
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American Psychiatric Association. Diagnostic and Statistical Manual of Mental Disorders. 5th ed. Arlington, VA: American Psychiatric Association; 2013. Available from: https://psicovalero.files.wordpress.com/2014/11/dsm-v-ingles-manual-diagnc 3b3stico-y-estadc3adstico-de-los-trastornos-mentales.pdf. [Last accessed on 2021 Aug 17].  Back to cited text no. 9
    
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Hamilton M. A rating scale for depression. J Neurol Neurosurg Psychiatry 1960;23:56-62.  Back to cited text no. 10
    
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Hamilton M. The assessment of anxiety states by rating. Br J Med Psychol 1959;32:50-5.  Back to cited text no. 11
    
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Yadav V, Jain A, Dabar D, Goel AD, Sood A, Joshi A, et al. A meta-analysis on the prevalence of depression in perimenopausal and postmenopausal women in India. Asian J Psychiatr 2021;57:102581.  Back to cited text no. 12
    
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Octavani C, Meiyanti M. The relationship of menopause with depression among women over 50 years old. JKKI: Jurnal Kedokteran dan Kesehatan Indonesia 2019;10:50-6.  Back to cited text no. 13
    
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Soares CN, Thase ME, Clayton A, Guico-Pabia CJ, Focht K, Jiang Q, et al. Desvenlafaxine and escitalopram for the treatment of postmenopausal women with major depressive disorder. Menopause 2010;17:700-11.  Back to cited text no. 14
    
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Demyttenaere K, Andersen HF, Reines EH. Impact of escitalopram treatment on quality of life enjoyment and satisfaction questionnaire scores in major depressive disorder and generalized anxiety disorder. Int Clin Psychopharmacol 2008;23:276-86.  Back to cited text no. 15
    
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Jiang K, Li L, Wang X, Fang M, Shi J, Cao Q, et al. Efficacy and tolerability of escitalopram in treatment of major depressive disorder with anxiety symptoms: A 24-week, open-label, prospective study in Chinese population. Neuropsychiatr Dis Treat 2017;13:515-26.  Back to cited text no. 16
    
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Bandelow B, Stein DJ, Dolberg OT, Andersen HF, Baldwin DS. Improvement of quality of life in panic disorder with escitalopram, citalopram, or placebo. Pharmacopsychiatry 2007;40:152-6.  Back to cited text no. 17
    
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Park HY, Lee BJ, Kim JH, Bae JN, Hahm BJ. Rapid improvement of depression and quality of life with escitalopram treatment in outpatients with breast cancer: A 12-week, open-label prospective trial. Prog Neuropsychopharmacol Biol Psychiatry 2012;36:318-23.  Back to cited text no. 18
    
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Endicott J, Lam RW, Hsu MA, Fayyad R, Boucher M, Guico-Pabia CJ. Improvements in quality of life with desvenlafaxine 50mg/d vs. placebo in employed adults with major depressive disorder. J Affect Disord 2014;166:307-14.  Back to cited text no. 19
    
20.
LaCroix AZ, Freeman EW, Larson J, Carpenter JS, Joffe H, Reed SD, et al. Effects of escitalopram on menopause-specific quality of life and pain in healthy menopausal women with hot flashes: A randomized controlled trial. Maturitas 2012;73:361-8.  Back to cited text no. 20
    



 
 
    Tables

  [Table 1], [Table 2], [Table 3], [Table 4], [Table 5], [Table 6]



 

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