Patients with a suboptimal response to the standard dose of selective serotonin reuptake inhibitors may receive escalating doses. The present study assessed the efficacy and safety of escitalopram dose escalation, up to 30 mg, in non-remitters with major depressive disorder (MDD) following the standard dose therapy.

The study recruited 98 patients with MDD (aged 18–65 years). After 4 weeks of open-label treatment with 10–20 mg of escitalopram/day, it randomized the non-remitters [Montgomery–Åsberg Depression Rating Scale (MADRS) score > 10] for treatment with either escitalopram (30 mg/day) or escitalopram (20 mg/day) plus placebo for 6 weeks. The study then assessed the change in the total MADRS score.

After four weeks of treatment, 12 patients showed remission, and 36 dropped out. Thus there were 50 non-remitters, of which 88% completed the double-blind study. The two groups showed a significant difference in the change in the total MADRS score at week 6 [−8.0 and −11.8 in the placebo and the escitalopram dose-escalation, respectively]. The patients tolerated the dose escalation of escitalopram well. However, the response, remission rates, and quality of life showed no significant differences.

This study signifies that dose escalation of escitalopram (up to 30 mg/day) may be beneficial for treating depressive symptoms in non-remitters after standard (10–20 mg/day) treatment.

Journal of Affective Disorders. 2019;259:91-97. https://doi.org/10.1016/j.jad.2019.08.057.