Lepola 2003.

Methods	Eight‐week, double‐blind, randomised, multicentre study.
Participants	Outpatients meeting DSM‐IV criteria for Major Depressive Disorder and having a total score on Montgomery‐Asberg Depression Rating Scale (MADRS) between 22 and 40. Age range: 18‐65 years. Exclusion criteria: mania or any bipolar disorder, schizophrenia or any psychotic disorder, obsessive‐compulsive disorder, eating disorder, mental retardation, any pervasive developmental disorder or cognitive disorder (according to DSM‐IV criteria), MADRS score >= 5 on item 10, treatment with antipsychotics, antidepressants, hypnotics, anxiolytics, barbiturates, chloral hydrate or other 5‐hydroxytryptamine receptor agonists, electroconvulsive treatment, treatment with behaviour therapy or psychotherapy.
Interventions	Escitalopram: 156 participants. Citalopram: 161 participants. Escitalopram dose range: 10‐20 mg/day. Citalopram dose range: 20‐40 mg/day. Benzodiazepines for insomnia were allowed.
Outcomes	Primary outcome: Change from baseline to week 8 in MADRS. Secondary Outcomes: Clinical Global Impression‐Improvement (CGI‐I), Clinical Global Impression‐Severity (CGI‐S), MADRS Individuals Items (apparent sadness, reported sadness, inner tension, reduced sleep, reduced appetite, concentration difficulties, lassitude, inability to feel, pessimistic thoughts, suicidal thoughts).
Notes	This study was funded by escitalopram manufacturer. One fetal death in female patient treated with citalopram; one unintended pregnancy in female patient treated with escitalopram. Remission: a score equal or less than 12 on MADRS.
Risk of bias
Bias	Authors' judgement	Support for judgement
Random sequence generation (selection bias)	Unclear risk	Quote: "Patients were randomized". Probably done.
Allocation concealment (selection bias)	Unclear risk	No information provided.
Blinding (performance bias and detection bias) All outcomes	Unclear risk	Quote: " there was an initial single blind placebo period, followed by randomization of eligible patients in a 1:1:1 ratio of escitalopram, citalopram and placebo treatment". The following weeks are in double‐blind conditions.
Incomplete outcome data (attrition bias) All outcomes	Low risk	Quote: "Intention‐to‐treat (ITT) population included all randomized patients who took at least one dose of double‐blind study product and who had at least one valid post‐baseline MADRS assessment."
Selective reporting (reporting bias)	High risk	Many rating scales listed in Methods, but only a few reported.
Other bias	Unclear risk	Sponsorship bias cannot be ruled out.