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    Selective serotonin reuptake inhibitors (SSRIs) are a widely used type of antidepressant. They're mainly prescribed to treat depression, particularly persistent or severe cases, and are often used in combination with a talking therapy such as cognitive behavioural therapy (CBT). SSRIs are usually the first choice medication for depression because they generally have fewer side effects than most other types of antidepressant. As well as depression, SSRIs can be used to treat a number of other mental health conditions, including: SSRIs can sometimes be used to treat other conditions, such as premature ejaculation, premenstrual syndrome (PMS), fibromyalgia and irritable bowel syndrome (IBS). Occasionally, they may also be prescribed to treat pain. It's thought that SSRIs work by increasing serotonin levels in the brain. Serotonin is a neurotransmitter (a messenger chemical that carries signals between nerve cells in the brain). The aim of this review was to assess the clinical relevance of the relative antidepressant efficacy of escitalopram and citalopram by meta-analysis. Studies in major depressive disorder (MDD) with both escitalopram and citalopram treatment arms were identified. Adult patients had to meet DSM-IV criteria for MDD. The primary outcome measure was the treatment difference in Montgomery–Asberg Depression Rating Scale (MADRS) total score at week 8 (or last assessment if =0.0002) (six RCTs used the MADRS), and in responder rate (8.3 percentage points, 95% CI 4.4–12.3) (eight RCTs) and remitter rate (17.6 percentage points, 95% CI 12.1–23.1) analyses (reported for four RCTs), corresponding to number-needed-to-treat (NNT) values of 11.9 ( Escitalopram has been found to have superior efficacy to other antidepressants in the treatment of major depressive disorder (MDD) in a number of individual studies and in a series of meta-analyses. Escitalopram has been shown to be superior to paroxetine (Boulenger . The superiority of escitalopram is even more clear-cut in severe depression, as shown in individual studies in which it was compared to citalopram (the racemic mixture of escitalopram and the R-enantiomer), paroxetine, and venlafaxine (Boulenger (2005) was designed to test prospectively for a possible difference between 20 mg escitalopram and 40 mg citalopram in patients with severe depression [Montgomery–Asberg Depression Rating Scale (MADRS; Montgomery & Åsberg, 1979) score of ⩾30], and the observed difference of 2.1 was significant and clinically relevant. In patients with very severe depression there is an even more striking treatment effect. In the study of Yevtushenko (2007) in severe depression (MADRS ⩾30, except for 12 patients) a difference of 3.51 for 10 mg escitalopram compared to 20 mg citalopram increases to 3.99 in very severe depression (MADRS ⩾35).

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