of the study was the observation of the efficacy and tolerability of escitalopram in patients with recurrent unipolar major depression (MD-RUP) over a 6-month period.

23 patients with MD-RUP in acute phase, diagnosed according to DSM-IV-R (DIGS-interview) were followed-up for 6 month from the beginning of the treatment with escitalopram (10mg-20mg/day). Five measurements were undertaken: on the first treatment day, after two weeks, one month, two months and six months of continuous treatment. Measurements included the modified Hamilton Rating Scale (25 items) (HAMD-25) (Miller et al, Psychiatry Research, 1984) for depressive and anxious symptoms and the CGI-S (Clinical Global Impression–Severity).

There were 3 drop-outs because of the drug side effects during the first treatment week. In the remaining 20 patients worsening of insomnia, anxiety, and concentration was noticed during the first two treatment weeks. In 20% (4/20) of the cases the reduced sleep accentuated the depression and generated pessimistic ideation during the first two weaks. The first significant improvement of the depressed mood, lack of energy, insomnia and concentration appeared after one month (p=0.05) in patients with reduced anxiety and after two months in patients with high anxiety. The remission remained stable in 80% (16/20) of the cases over 6 months.

The study investigated a small sample and had no placebo control group.

Escitalopram may worsen some symptoms like insomnia and anxiety in the clinical picture of major depression during the first two weeks of treatment.