Tandospirone and Escitalopram Provide Different Symptomatic Benefits in Multiple System Atrophy-Cerebellar Ataxia


A recent study revealed that tandospirone citrate exhibits more positive effects in alleviating depression/anxiety and cerebellar ataxia symptoms in patients with multiple system atrophy-cerebellar subtype compared with escitalopram oxalate.

In the Journal of Psychiatric Research, an open-label, non-controlled, observational study showed that tandospirone citrate, an anxiolytic drug, demonstrated more beneficial effects in reducing depression/anxiety and cerebellar ataxia symptoms in patients with multiple system atrophy-cerebellar subtype (MSA-C) compared with escitalopram oxalate, an antidepressant drug. Escitalopram oxalate showed a more beneficial effect in reducing autonomic dysfunction symptoms.1

Among 56 patients with MSA-C, investigators observed a more substantial reduction in the Hamilton Anxiety Rating Scale (HAMA)/Hamilton Depression Rating Scale (HAMD), scores of stance, finger tracking, and finger nose test on the Scale for the Assessment and Rating of Ataxia (SARA), and post-void residual urine volume (PVR) in the tandospirone group (n = 28)(P's <.05). There was a more substantial reduction in scores of dysuria, light-headed when standing up, syncope and hyperhidrosis on the Scale for Outcomes in Parkinson's Disease for Autonomic Symptoms (SCOPA-AUT) in the escitalopram group (n = 28)(P's <.05).

Top Clinical Takeaways

  • Tandospirone exhibits superior efficacy in reducing depression/anxiety symptoms and cerebellar ataxia in patients with MSA-C compared with escitalopram.
  • Escitalopram outperforms tandospirone in reducing autonomic dysfunction symptoms, including syncope and hyperhidrosis.
  • Despite limitations such as small sample sizes and lack of a placebo control group, the study suggests tandospirone's potential as a therapeutic option for MSA-C.

“A greater reduction in depression/anxiety symptoms in the tandospirone group than in the escitalopram group suggests that tandospirone could be a better choice as an antidepressant/anxiolytic agent in patients with MSA-C and depression/anxiety symptoms,” lead author Meina Quan, MD, PhD, researcher at the Innovation Center for Neurological Disorders and Department of Neurology, Xuanwu Hospital, Capital Medical University, in Beijing, China, and colleagues wrote.1 “Our results extend the potential beneficial effects of MSA-C in that it showed more beneficial effects than escitalopram in reducing depression/anxiety symptoms, which broadens its usage in the clinical field and verifies the efficacy of 5-HT1A in reducing depression and anxiety symptoms.”

READ MORE: Case Study Reveals Novel Intragenic Deletion of the FXN Gene in Friedreich Ataxia

In the study, investigators included patients with MSA-C who also had subthreshold depression/anxiety symptoms. Participants received either escitalopram oxalate 10 mg/day or tandospirone citrate 30 mg/day and were assessed after 4 weeks of treatment. The researchers evaluated the participants with several psychiatric and neurological tests, including the HAMA, HAMD, SARA, and the SCOPA-AUT. In addition, investigators measured PVR and blood pressure in the participants.

“In our study, dysuria and PVR improved more significantly in the tandospirone treatment group than in the escitalopram group, indicating the potential efficacy of tandospirone in improving urinary dysfunction,” Quan et al noted.1 “The escitalopram treatment group showed greater improvement in syncope and hyperhidrosis than the tandospirone treatment group, indicating the potential efficacy of escitalopram in improving cardiovascular and skin autonomic dysfunction in MSA-C.”

During the treatment period, the 2 therapies were safe and well tolerated in both participant groups, with no serious adverse events occurring. Of note, 2 patients reported nausea, 1 patient reported loss of appetite, and 2 reported dizziness during the treatment in tandospirone group. In addition, 2 patients from the escitalopram group reported constipation. The authors noted that the adverse effects that occurred during the treatment period disappeared spontaneously between 3 and 7 days without special treatment.

All told, limitations of the study included the relatively small patients’ cohorts and thus, the results should be interpreted with caution. The study also lacked a placebo or blank control group and so, the interpretation of the findings requires caution, and the placebo effect cannot be controlled for. Additionally, authors noted postmortem neuropathological evaluation was unavailable, and misdiagnosis could not be ruled out in the study. Investigators also noted that the study was not a multicenter or double-blind trial, and short-term observations may limit the results.

“In the future, we expect more studies with large sample sizes and a double-blind design in multiple centers with long-term follow-up to confirm the therapeutic effects of tandospirone and escitalopram in MSA-C,” Quan et al noted.1

1. Quan M, Gao J, Xu S, Guo D, Jia J, Wang W. Comparison of tandospirone and escitalopram as a symptomatic treatment in Multiple System Atrophy-cerebellar ataxia: An open-label, non-controlled, 4 weeks observational study. J Psychiatr Res. 2023;168:133-139. doi:10.1016/j.jpsychires.2023.10.028
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