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Some Paroxetine-Intolerant Depressed Patients Can Tolerate Citalopram

Patients with major depressive disorder who are intolerant to paroxetine may be able to tolerate citalopram.

United States researchers enrolled 61 outpatients, who had proven to be intolerant to paroxetine in a previous trial, for a six-weeks open-label trial of citalopram therapy. The study design allowed citalopram to be titrated up to a maximum of 40 mg per day after a one wee-washout period.

The mean intent-to-treat dose was 23.9 mg/day. Fifty-three (87 percent) patients completed the six weeks of treatment and six patients (10 percent) dropped out because of adverse events.

Response was measured using the Clinical Global Impressions (CGI) scale, the Hamilton Rating Scale for Depression and several other measures of symptoms and quality of life.

Side effects that patients reported to be intolerable during the trial of paroxetine recurred less than 30 percent of the time with citalopram, the researchers point out.

Intent-to-treat CGI response was 56 percent at study end point, with 62 percent of those completing the trial responding. There was significant improvement from pre-treatment on various symptom measures after two weeks of citalopram treatment.

"Although further work is necessary to assess the relative merits of this within-class switching strategy, as compared to other options, these data provide further evidence that the various selective serotonin reuptake inhibitors do not have interchangeable tolerability profiles," write the investigators, led by Dr. Michael Thase of the University of Pittsburgh School of Medicine in Pittsburgh, Pennsylvania.

They concluded that citalopram was well tolerated, with more than half of patients improving significantly.
Depression and Anxiety, 2002; 6:128-133. "Citalopram treatment of paroxetine-intolerant depressed patients"

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