Efficacy of escitalopram in the treatment of social anxiety disorder: A meta-analysis versus placebo

Escitalopram is the most selective of the serotonin reuptake inhibitor (SSRI) antidepressants. We conducted a meta-analysis of placebo-controlled studies where escitalopram was used to treat patients with social anxiety disorder (SAD). Data from all randomised, double-blind placebo-controlled studies in SAD with escitalopram from both specialist settings and general practice were used. Patients met the DSM-IV criteria for SAD, were ≥18 years old, and had a Liebowitz Social Anxiety Scale (LSAS) ≥60. The primary outcome measure was the estimated treatment difference in LSAS total score at Week 12. Secondary outcome measures included the estimated treatment difference in the Clinical Global Impression-Severity (CGI-S) score at Week 12. A total of 1598 patients from 3 randomised controlled trials were included in the analyses. Escitalopram (n=1061) was superior to placebo (n=537), with an estimated treatment difference on the LSAS of −9.2 points (95%CI: [−14.4; −4.0], p<0.01) (escitalopram 5 mg/day), −4.6 points (95%CI: [−8.1; −1.0], p<0.01) (escitalopram 10 mg/day), −10.1 points (95%CI: [−13.7; −6.5], p<0.01) (escitalopram 20 mg/day) and −7.3 points (95%CI: [−12.3; −2.2], p<0.01) (escitalopram 10-20 mg/day). For the CGI-S, the corresponding values were −0.55 points (95%CI: [−0.79; −0.31], p<0.01) (escitalopram 5 mg/day), −0.26 points (95%CI: [−0.42; −0.10], p<0.01) (escitalopram 10 mg/day), −0.48 points (95%CI: [−0.64; −0.31], p<0.01) (escitalopram 20 mg/day) and −0.29 points (95%CI: [−0.51; −0.07], p<0.05) (escitalopram 10-20 mg/day). The withdrawal rate due to adverse events was 7.2% for escitalopram, compared with 4.3% for placebo (p<0.05). In this meta-analysis, all doses of escitalopram showed significant superiority in efficacy versus placebo in the treatment of patients with SAD.