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Escitalopram response

MedGen UID:
808074
Concept ID:
CN221264
Sign or Symptom
Synonym: Lexapro response
Drug:
Escitalopram
MedGen UID:
203862
Concept ID:
C1099456
Pharmacologic Substance
The active S-stereoisomer of the selective serotonin reuptake inhibitor (SSRI) citalopram with antidepressant, anti-obsessive-compulsive and antibulimic properties. Escitalopram inhibits the reuptake of the neurotransmitter serotonin (5-HT) at the serotonin reuptake pump of the neuronal membrane of the presynaptic cell, thereby increasing levels of 5-HT within the synaptic cleft and enhancing the actions of serotonin on 5HT1A autoreceptors. Unlike other SSRIs, escitalopram appears to not only bind to a primary high-affinity site on the serotonin transporter protein but also to a secondary lower-affinity allosteric site that is considered to stabilize and prolong drug binding. [from NCI]
 
Gene (location): CYP2C19 (10q23.33)

Definition

Serotonin reuptake inhibitor antidepressants, such as selective serotonin reuptake inhibitors (SSRIs), serotonin and norepinephrine reuptake inhibitors (SNRIs), and serotonin modulators with SSRI-like properties are pharmacotherapy options for major depressive and anxiety disorders. Inadequate response and treatment-related adverse events are known challenges in antidepressant therapy. Genetic variations in genes encoding the drug metabolizing enzymes, CYP2D6, CYP2C19 and CYP2B6, have been shown to alter antidepressant biotransformation, which may potentially affect dosing, efficacy, and tolerability. [from PharmGKB]

Term Hierarchy

CClinical test,  RResearch test,  OOMIM,  GGeneReviews,  VClinVar  

Professional guidelines

PubMed

Crandall CJ, Mehta JM, Manson JE
JAMA 2023 Feb 7;329(5):405-420. doi: 10.1001/jama.2022.24140. PMID: 36749328
Selph SS, McDonagh MS
Am Fam Physician 2019 Nov 15;100(10):609-617. PMID: 31730312
Cipriani A, Furukawa TA, Salanti G, Chaimani A, Atkinson LZ, Ogawa Y, Leucht S, Ruhe HG, Turner EH, Higgins JPT, Egger M, Takeshima N, Hayasaka Y, Imai H, Shinohara K, Tajika A, Ioannidis JPA, Geddes JR
Lancet 2018 Apr 7;391(10128):1357-1366. Epub 2018 Feb 21 doi: 10.1016/S0140-6736(17)32802-7. PMID: 29477251Free PMC Article

Curated

CPIC® Guideline for Serotonin Reuptake Inhibitor Antidepressants and CYP2D6, CYP2C19, CYP2B6, SLC6A4, and HTR2A, 2023

DailyMed Drug Label, escitalopram, 2021

Recent clinical studies

Etiology

Fiori LM, Orri M, Aouabed Z, Théroux JF, Lin R, Nagy C, Frey BN, Lam RW, MacQueen GM, Milev R, Müller DJ, Parikh SV, Rotzinger S, Uher R, Foster JA, Kennedy SH, Turecki G
Transl Psychiatry 2021 Aug 21;11(1):439. doi: 10.1038/s41398-021-01564-8. PMID: 34420030Free PMC Article
Basu A, Chadda R, Sood M, Rizwan SA
Asian J Psychiatr 2017 Aug;28:154-159. Epub 2017 May 15 doi: 10.1016/j.ajp.2017.04.029. PMID: 28784374
Najjar F, Owley T, Mosconi MW, Jacob S, Hur K, Guter SJ, Sweeney JA, Gibbons RD, Cook EH, Bishop JR
J Child Adolesc Psychopharmacol 2015 Aug;25(6):467-74. doi: 10.1089/cap.2014.0158. PMID: 26262902Free PMC Article
Lopez-Vilchez I, Serra-Millas M, Navarro V, Rosa Hernandez M, Villalta J, Diaz-Ricart M, Gasto C, Escolar G, Galan AM
J Affect Disord 2014 Apr;159:39-45. Epub 2014 Feb 20 doi: 10.1016/j.jad.2014.02.022. PMID: 24679387
Lam RW, Andersen HF, Wade AG
Int Clin Psychopharmacol 2008 Jul;23(4):181-7. doi: 10.1097/YIC.0b013e3282ffdedc. PMID: 18545055

Diagnosis

Caspani G, Turecki G, Lam RW, Milev RV, Frey BN, MacQueen GM, Müller DJ, Rotzinger S, Kennedy SH, Foster JA, Swann JR
Commun Biol 2021 Jul 22;4(1):903. doi: 10.1038/s42003-021-02421-6. PMID: 34294869Free PMC Article
Lopez-Vilchez I, Serra-Millas M, Navarro V, Rosa Hernandez M, Villalta J, Diaz-Ricart M, Gasto C, Escolar G, Galan AM
J Affect Disord 2014 Apr;159:39-45. Epub 2014 Feb 20 doi: 10.1016/j.jad.2014.02.022. PMID: 24679387

Therapy

Fiori LM, Orri M, Aouabed Z, Théroux JF, Lin R, Nagy C, Frey BN, Lam RW, MacQueen GM, Milev R, Müller DJ, Parikh SV, Rotzinger S, Uher R, Foster JA, Kennedy SH, Turecki G
Transl Psychiatry 2021 Aug 21;11(1):439. doi: 10.1038/s41398-021-01564-8. PMID: 34420030Free PMC Article
Dunlop K, Rizvi SJ, Kennedy SH, Hassel S, Strother SC, Harris JK, Zamyadi M, Arnott SR, Davis AD, Mansouri F, Schulze L, Ceniti AK, Lam RW, Milev R, Rotzinger S, Foster JA, Frey BN, Parikh SV, Soares CN, Uher R, Turecki G, MacQueen GM, Downar J
Neuropsychopharmacology 2020 Jul;45(8):1390-1397. doi: 10.1038/s41386-020-0688-x. PMID: 32349119Free PMC Article
Basu A, Chadda R, Sood M, Rizwan SA
Asian J Psychiatr 2017 Aug;28:154-159. Epub 2017 May 15 doi: 10.1016/j.ajp.2017.04.029. PMID: 28784374
Powell TR, Schalkwyk LC, Heffernan AL, Breen G, Lawrence T, Price T, Farmer AE, Aitchison KJ, Craig IW, Danese A, Lewis C, McGuffin P, Uher R, Tansey KE, D'Souza UM
Eur Neuropsychopharmacol 2013 Sep;23(9):1105-14. Epub 2012 Nov 9 doi: 10.1016/j.euroneuro.2012.09.009. PMID: 23142150
Ji Y, Hebbring S, Zhu H, Jenkins GD, Biernacka J, Snyder K, Drews M, Fiehn O, Zeng Z, Schaid D, Mrazek DA, Kaddurah-Daouk R, Weinshilboum RM
Clin Pharmacol Ther 2011 Jan;89(1):97-104. Epub 2010 Nov 24 doi: 10.1038/clpt.2010.250. PMID: 21107318Free PMC Article

Prognosis

Caspani G, Turecki G, Lam RW, Milev RV, Frey BN, MacQueen GM, Müller DJ, Rotzinger S, Kennedy SH, Foster JA, Swann JR
Commun Biol 2021 Jul 22;4(1):903. doi: 10.1038/s42003-021-02421-6. PMID: 34294869Free PMC Article
Dunlop K, Rizvi SJ, Kennedy SH, Hassel S, Strother SC, Harris JK, Zamyadi M, Arnott SR, Davis AD, Mansouri F, Schulze L, Ceniti AK, Lam RW, Milev R, Rotzinger S, Foster JA, Frey BN, Parikh SV, Soares CN, Uher R, Turecki G, MacQueen GM, Downar J
Neuropsychopharmacology 2020 Jul;45(8):1390-1397. doi: 10.1038/s41386-020-0688-x. PMID: 32349119Free PMC Article
Basu A, Chadda R, Sood M, Rizwan SA
Asian J Psychiatr 2017 Aug;28:154-159. Epub 2017 May 15 doi: 10.1016/j.ajp.2017.04.029. PMID: 28784374
Najjar F, Owley T, Mosconi MW, Jacob S, Hur K, Guter SJ, Sweeney JA, Gibbons RD, Cook EH, Bishop JR
J Child Adolesc Psychopharmacol 2015 Aug;25(6):467-74. doi: 10.1089/cap.2014.0158. PMID: 26262902Free PMC Article
Powell TR, Schalkwyk LC, Heffernan AL, Breen G, Lawrence T, Price T, Farmer AE, Aitchison KJ, Craig IW, Danese A, Lewis C, McGuffin P, Uher R, Tansey KE, D'Souza UM
Eur Neuropsychopharmacol 2013 Sep;23(9):1105-14. Epub 2012 Nov 9 doi: 10.1016/j.euroneuro.2012.09.009. PMID: 23142150

Clinical prediction guides

Caspani G, Turecki G, Lam RW, Milev RV, Frey BN, MacQueen GM, Müller DJ, Rotzinger S, Kennedy SH, Foster JA, Swann JR
Commun Biol 2021 Jul 22;4(1):903. doi: 10.1038/s42003-021-02421-6. PMID: 34294869Free PMC Article
Dunlop K, Rizvi SJ, Kennedy SH, Hassel S, Strother SC, Harris JK, Zamyadi M, Arnott SR, Davis AD, Mansouri F, Schulze L, Ceniti AK, Lam RW, Milev R, Rotzinger S, Foster JA, Frey BN, Parikh SV, Soares CN, Uher R, Turecki G, MacQueen GM, Downar J
Neuropsychopharmacology 2020 Jul;45(8):1390-1397. doi: 10.1038/s41386-020-0688-x. PMID: 32349119Free PMC Article
Basu A, Chadda R, Sood M, Rizwan SA
Asian J Psychiatr 2017 Aug;28:154-159. Epub 2017 May 15 doi: 10.1016/j.ajp.2017.04.029. PMID: 28784374
Powell TR, Schalkwyk LC, Heffernan AL, Breen G, Lawrence T, Price T, Farmer AE, Aitchison KJ, Craig IW, Danese A, Lewis C, McGuffin P, Uher R, Tansey KE, D'Souza UM
Eur Neuropsychopharmacol 2013 Sep;23(9):1105-14. Epub 2012 Nov 9 doi: 10.1016/j.euroneuro.2012.09.009. PMID: 23142150
Ji Y, Hebbring S, Zhu H, Jenkins GD, Biernacka J, Snyder K, Drews M, Fiehn O, Zeng Z, Schaid D, Mrazek DA, Kaddurah-Daouk R, Weinshilboum RM
Clin Pharmacol Ther 2011 Jan;89(1):97-104. Epub 2010 Nov 24 doi: 10.1038/clpt.2010.250. PMID: 21107318Free PMC Article

Supplemental Content

Table of contents

    Clinical resources

    Practice guidelines

    • PubMed
      See practice and clinical guidelines in PubMed. The search results may include broader topics and may not capture all published guidelines. See the FAQ for details.

    Curated

    • CPIC, 2023
      CPIC® Guideline for Serotonin Reuptake Inhibitor Antidepressants and CYP2D6, CYP2C19, CYP2B6, SLC6A4, and HTR2A, 2023
    • DailyMed Drug Label, 2021
      DailyMed Drug Label, escitalopram, 2021

    Consumer resources

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