Citalopram Treatment of Fluoxetine Nonresponders
J Clin Psychiatry 2001;62(9):683-687
© Copyright 2017 Physicians Postgraduate Press, Inc.
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Background: We assessed the tolerability and
utility of switching fluoxetine nonresponders to citalopram the
day that fluoxetine therapy was stopped.
Method: Fifty-eight outpatients with DSM-IV
major depressive episode and prospectively confirmed nonresponse
to fluoxetine (mean final dose = 31 mg/day) were switched
directly to citalopram (20 mg/day). Of the 58 patients, 44 (76%)
had never been successfully treated with antidepressant
medication. During a 12-week open-label treatment period,
citalopram could be titrated up to a maximum dose of 60 mg/day.
Response was evaluated using the Clinical Global Impressions
(CGI) scale, the 24-item Hamilton Rating Scale for Depression,
and several other measures.
Results: Eighty-one percent (N = 47) completed
the trial, and citalopram (mean dose = 38.8 mg/day) was well
tolerated. The intent-to-treat CGI response rate was 46% (26/57)
at week 6 and 63% (36/57) at study endpoint; the completer
response rate was 76% among the 47 patients who completed the
12-week trial. Improvement from baseline on all dependent
measures was statistically significant after the first week of
Conclusion: Fluoxetine nonresponders can be
quickly switched to citalopram, with good tolerability and
reasonable chance of therapeutic benefit. Further work is
necessary to assess the merits of this treatment strategy
relative to other options.