Citalopram in the Maintenance Treatment of Major Depressive Disorder

Letter to the Editor

Sir: I read with interest the article by Franchini and colleagues on citalopram in the maintenance treatment of major depressive disorder (MDD). The study showed that no relapse was observed in the 4-month continuation period, during which patients were maintained on citalopram, 40 mg/day. However, during the 24-month maintenance phase, the dose was reduced to 20 mg/day, and 50% of patients had a new recurrence. The study did not have a placebo or a control arm. The results seem to contradict previous findings on the long-term efficacy of citalopram. The most likely cause for the high rate of recurrence in the report by Franchini et al. is the reduction in the dose of citalopram during the maintenance phase.