A COMPARATIVE STUDY ON SAFETY, EFFICACY AND PHARMACOTHERAPEUTIC ADHERENCE OF DESVENLAFAXINE VERSUS ESCITALOPRAM IN DEPRESSION AT A TERTIARY CARE TEACHING HOSPITAL

INTRODUCTIONMajor Depressive Disorder (MDD) is a prevalent mental health condition, with pharmacological treatments like Escitalopram (SSRI) and Desvenlafaxine (SNRI) being widely used. This study compared their efficacy, safety, adherence and metabolic effects in MDD patients. OBJECTIVESThe primary objective was to evaluate depressive symptom reduction using the Hamilton Depression Rating Scale (HAM-D) over 16 weeks. Secondary objectives included assessing lipid profiles, platelet counts, adverse effects and adherence. METHODSThis prospective observational study included 203 MDD patients (Escitalopram: n=105; Desvenlafaxine: n=98). HAM-D scores, lipid profiles, and platelet counts were evaluated at baseline and week 16. Adverse effects were monitored throughout the study. RESULTSBoth treatments significantly reduced HAM-D scores (p < 0.001), with Escitalopram showing greater improvement at all time points (p < 0.001). Escitalopram improved lipid profiles, reducing TC (p < 0.001), TG (p < 0.001), and VLDL (p < 0.001), while increasing HDL (p < 0.001). LDL remained unchanged (p = 0.842). Desvenlafaxine increased TC (p < 0.001) and VLDL (p < 0.001) but also raised HDL (p < 0.001), with no significant changes in TG (p = 0.954) or LDL (p = 0.839). Platelet counts decreased slightly with Escitalopram (p = 0.012) but remained stable with Desvenlafaxine (p = 0.806). Adverse effects were more frequent with Desvenlafaxine (9.2% at 4 weeks) than Escitalopram (6.7%). CONCLUSIONEscitalopram demonstrated superior efficacy in reducing depressive symptoms and a more favourable impact on lipid profiles compared to Desvenlafaxine, which had a higher incidence of adverse effects. Escitalopram is preferable for MDD patients with metabolic concerns, while Desvenlafaxine remains a viable alternative with careful monitoring. Individualized treatment strategies are essential for optimal MDD management.