Citalopram Therapy for Depression: A Review of 10 Years of European Experience and Data From U.S. Clinical Trials

Background: This review summarizes andevaluates clinical experience with citalopram, the latestselective serotonin reuptake inhibitor (SSRI) to be approved forthe treatment of depression in the United States.

Data Sources: Published reports of randomized,double-blind, controlled clinical studies of citalopram wereretrieved using a MEDLINE literature search. Search termsincluded citalopram, SSRI, TCA (tricylic antidepressant),depression, and clinical. For each study, data onantidepressant efficacy and adverse events were evaluated.Pharmacokinetic studies and case reports were reviewed tosupplement the evaluation of citalopram’s safety andtolerability. Data presented at major medical conferences andpublished in abstract form also were reviewed.

Study Findings: Thirty randomized, double-blind,controlled studies of the antidepressant efficacy of citalopramwere located and reviewed. In 11 studies, citalopram was comparedwith placebo (1 of these studies also included comparison withanother SSRI). In 4 additional studies, the efficacy ofcitalopram in preventing depression relapse or recurrence wasinvestigated. In another 11 studies (including 1 meta-analysis ofpublished and unpublished trials), citalopram was compared withtricyclic and tetracyclic antidepressants. Finally, results areavailable from 4 studies in which citalopram was compared withother SSRIs. A placebo-controlled study of citalopram for thetreatment of panic disorder was reviewed for data on long-termadverse events.

Conclusion: Data published over the lastdecade suggest that citalopram is (1) superior to placebo in thetreatment of depression, (2) has efficacy similar to that of thetricyclic and tetracyclic antidepressants and to other SSRIs, and(3) is safe and well tolerated in the therapeutic dose range of20 to 60 mg/day. Distinct from some other agents in its class,citalopram exhibits linear pharmacokinetics and minimal druginteraction potential. These features make citalopram anattractive agent for the treatment of depression, especiallyamong the elderly and patients with comorbid illness.