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Citalopram Therapy Effective in Treating Social Anxiety Disorder and Comorbid Major Depressive Disorder

Citalopram appears to be an effective treatment option for patients both social anxiety disorder and major depressive disorder (MDD).

Previous studies have demonstrated that social anxiety disorder and MDD frequently occur together, especially in MDD with atypical features. Despite this recognition, little attention has been given to assessing treatment for patients with comorbid conditions.

Because serotonin reuptake inhibitors (SSRIs) as a class are considered effective in treating social anxiety disorder and MDD as separate conditions, Franklin R. Schneier, M.D. of the New York State Psychiatric Institute in New York, United States, and colleagues conducted an open label trial of citalopram in 21 patients with social anxiety disorder and comorbid MDD to determine efficacy against symptoms when the conditions occur together.

Patients were included in the study based on a clinical evaluation confirming current social anxiety disorder and MDD (using A Structured Clinical Interview for DSM-IV), with social anxiety disorder temporally primary or clinically predominant in relationship to MDD.

Administration of citalopram occurred for up to 12 weeks. The initial dose of 20 mg/day was increased another 20 mg/day every 2 weeks to 60 mg/day at 6 weeks, after which dosage was manipulated according to patient response and adverse events.

Patient symptoms were clinically assessed using the LSAS and Clinical Global Impression (CGI), and the 29-item Hamilton Rating Scale for Depression (HRSD-29) on a weekly schedule for the first 4 weeks, a 2 week schedule for weeks 5 to 8, and finally at 12 weeks.

Of the original patient population, 66.7% completed the trial. One patient discontinued the trial citing adverse effects due to citalopram (increased anxiety, restlessness, dizziness, mood swings, and insomnia), however, overall the treatment was well tolerated.

Among patients completing the study, an 85.7% response rate for social anxiety disorder and 100% response rate for MDD were observed based on patient and physician rated CGI scores.

Social anxiety scores consistently lagged behind those of MDD. The mean endpoint of LSAS (49.8, sd = 27.3) indicated the presence of clinically significant symptoms of social anxiety disorder, while an HRSD-21 score (5.1, sd = 5.9) indicated MDD remission.

"This finding should encourage clinicians to stay the course of an 8 to 12 week SSRI trial, even when there may be little early improvement in social anxiety symptoms relative to MDD improvement," investigators note.

The researchers conclude by recommending a placebo-controlled study to further examine the efficacy of citalopram in treating this patient population.

The study was funded by a grant from Forest Pharmaceuticals.
Depress Anxiety 2003;17:4:191-6. "Citalopram treatment of social anxiety disorder with comorbid major depression"

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