Citalopram as Adjunctive Therapy in Bipolar Depression
J Clin Psychiatry 2001;62(12):985-990
© Copyright 2014 Physicians Postgraduate Press, Inc.
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Background: The treatment of bipolar depression remains a major
clinical challenge. The effectiveness and safety of adjunctive citalopram were
evaluated in DSM-IV-diagnosed bipolar depressed patients in a 5-site study.
Method: The treatment strategy consisted of an open-label add-on
design in which patients received 8 weeks of acute treatment with citalopram
adjunctive to their ongoing treatment with mood stabilizers. Ongoing treatment
with 1 antipsychotic, 1 anxiolytic, and 1 hypnotic agent was permitted. Responders
to the 8-week trial then received 16 weeks of additional treatment with citalopram.
Results: Forty-five subjects entered the trial; 12 dropped out
before the end of the acute treatment phase. Of the 33 patients who completed
the acute treatment phase, 64% (N = 21) were responders and 36% (N = 12) were
nonresponders. In the continuation phase of the study, 14 patients achieved
sustained remission, 3 patients did not achieve remission before completing
16 weeks of continuation treatment, 2 patients experienced a relapse, and 2
patients dropped out of the study and did not have a chance to remit. In spite
of the extensive concomitant medication usage allowed in this study, citalopram
treatment was well tolerated and the level of reported adverse events (including
headache, nausea, diarrhea, and sexual dysfunction) relatively low.
Conclusion: The high response rate, the high rate of sustained
remission, and the low rate of adverse events strongly support the use of citalopram
as a treatment for bipolar I or II depression. These findings should stimulate
a controlled double-blind trial to demonstrate even more clearly the usefulness
of this drug in the therapeutic regimen for bipolar disorder.