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The Effectiveness of Citalopram for Idiopathic Chronic Fatigue

J Clin Psychiatry 2003;64:927-935

Background: Chronic fatigue greatly affects quality of life and is a common reason for physician visits. Patients with chronic fatigue are often treated with antidepressants.

Method: Prior to enrollment, all subjects had substantial fatigue for 6 months or more that was not explained by depression, organic illness, or lifestyle behaviors. Patients already taking an antidepressant were excluded from the study. Two designs were used. (1) Thirty-one subjects were given placebo for 1 week and then citalopram, 20 to 40 mg/day, for 2 months. Statistical testing evaluated whether fatigue (measured with the Rand Vitality Index) was reduced after citalopram was started. (2) Fatigue changes for subjects taking citalopram were compared with fatigue changes after 1 month and 2 months for 76 similar subjects taking an ineffective treatment.

Results: In design 1, fatigue for subjects taking citalopram was significantly and substantially reduced when subjects were switched from placebo to citalopram, p < .05. Benefits at 2 months were greatest for subjects who had fatigue less than 5 years, p < .01, and women, p < .01. In design 2, fatigue scores for subjects taking citalopram were not significantly better than the comparison group for all subjects but were significantly better at 2 months for subjects with less severe fatigue at baseline, p = .005, and for women, p = .08. Depression scores were not significantly better for citalopram subjects overall (p > .10) but were for certain subgroups. For all subjects, citalopram was associated with greater decrease in headaches and muscle aches at 1 month, p < .01.

Conclusion: Citalopram may improve fatigue and symptoms associated with fatigue for some patients.