Effectiveness and Tolerability of Escitalopram and Venlafaxine in Major Depressive Disorder: A Prospective Observational Study

Background: Major Depressive Disorder (MDD) requires effective and tolerable antidepressants. Escitalopram (SSRI) and venlafaxine (SNRI) are commonly prescribed, but real-world comparisons with flexible dosing are limited. Objective: To evaluate the effectiveness and tolerability of escitalopram and venlafaxine in MDD patients Materials and Methods: A 12-week prospective observational study was conducted on 110 patients at Santosh Medical College, Ghaziabad, in collaboration with the Psychiatry Department. Patients with major depressive disorder, prescribed escitalopram (10–20 mg) or venlafaxine (75–225 mg) by the treating psychiatrist, were enrolled. The Institutional Ethics Committee approved the study, and informed consent was obtained from the patient as per the Declaration of Helsinki. The treating psychiatrist assessed depression severity using the Hamilton Depression Rating Scale (HAM-D) at baseline and at weeks 4, 8, and 12 during follow-up at the hospital. Response and remission were evaluated at week 12, and tolerability was assessed using the UKU Side Effect Rating Scale. Data were analyzed on an intent-to-treat basis using the last observation carried forward method. Results: Of 110 patients, 55 received escitalopram (range 10–20 mg) and 55 venlafaxine (range 75–225 mg). Both groups showed significant symptom improvement. Venlafaxine produced greater HAM-D score reductions than escitalopram at Week 8 (10.7 ± 3.1 vs 12.1 ± 3.6, p = 0.042) and Week 12 (6.0 ± 2.1 vs 6.9 ± 2.3, p = 0.037 respectively but response (78.2% vs. 74.5%) and remission rates (56.4 % vs. 61.8%) were similar (p = 0.56). Venlafaxine had a higher overall side effect burden (p=0.008), with no significant difference in specific adverse events. Conclusion: In clinical practice, escitalopram (dose range 10–20 mg) and venlafaxine (dose range 75–225 mg) effectively treat MDD. Venlafaxine showed slightly greater symptom reduction, while escitalopram was better tolerated. Dose adjustments by the treating psychiatrist minimized side effects to improve tolerability.