Citalopram Treatment of Fluoxetine-Intolerant Depressed Patients
J Clin Psychiatry 2003;64(5):562-567
© Copyright 2017 Physicians Postgraduate Press, Inc.
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Background: We assessed the tolerability of and
response to citalopram in depressed patients who had discontinued
fluoxetine treatment due to adverse events.
Method: Fifty-five outpatients with DSM-IV major
depressive disorder and a confirmed history of intolerance to
fluoxetine (mean final dose = 24.6 mg/day) were switched to
citalopram (20 mg/day) after a 2- to 4-week single-blind placebo
washout period. During a 6-week, open-label treatment protocol,
citalopram could be titrated up to 40 mg/day. Safety and
tolerability, including reemergence of symptoms that previously
had been associated with fluoxetine, were assessed by recording
all spontaneously reported or observed adverse events. Efficacy
was evaluated using the Hamilton Rating Scale for Depression
(HAM-D), the Clinical Global Impressions (CGI) scale, and several
other measures. Response was defined as a CGI-Improvement score
at endpoint of 1 or 2 (i.e., very much or much improved).
Results: Ninety-five percent of patients (N =
52) completed the citalopram trial. The only adverse events
reported by more than 5 patients (>= 10%) were pharyngitis
(15%) and constipation (11%), and none of the 3 early
terminations were attributed to adverse events. The rate of
recurrence of the fluoxetine-associated adverse events was low,
with headache (3 [27%] of 11 cases), nausea (2 [22%] of 9 cases),
and decreased libido (5 [18%] of 28 cases) being the most common.
Significant improvement from baseline HAM-D (p < .001) was
observed by the first week of citalopram therapy and continued
until study end. The intent-to-treat CGI response rate was 65%
(36 of 55 patients) at study endpoint; 69% (36 of 52 patients) of
the completers responded.
Conclusion: These data suggest that
fluoxetine-intolerant patients can be treated effectively with