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Citalopram Significantly Reduces Relapses in Patients with Seasonal Affective Disorder Responsive to Light Therapy

Moderately depressed patients with seasonal affective disorder (SAD) who respond to light therapy have a significantly reduced rate of relapse if further treated with citalopram, reports a study from Denmark.

Light therapy and the selective serotonin reuptake inhibitors (SSRIs) are both effective in treating SAD, with light therapy associated with an early onset of action and the SSRIs a slower onset.

In this randomised, placebo-controlled trial, Klaus Martiny, Psychiatric Research Unit, Frederiksborg General Hospital, Denmark, and colleagues first evaluated the effect of 1-week of light therapy in 269 moderately depressed persons with SAD based primarily on the 17-item Hamilton depression score (HAM-D₁₇). Other depression scores used included the 6-item depression subscale (HAM-D₆), the Melancholia Scale (MES), and the Structured Interview Guide for Seasonal Affective Disorders (SIGH-SAD). Assessment of the global outcome of treatment was based on the total HAM-D₁₇ plus SIGN-SAD (HAM-D/SIGH-SAD). Patients who responded to the light therapy were then randomised to continuation therapy either on the SSRI citalopram or placebo to assess the effect of citalopram on relapse rates.

Of the 269 patients, 62.5% responded to light therapy based on the HAM-D₁₇ and HAM-D₆, 56.1% based on the HAM-D/SIGH-SAD, 52.8% based on MES, and 52.4% based on SIGH-SAD. Using the 62.5% response rate, 84 patients were then randomised to placebo and 84 to citalopram (26.3 mg mean daily dose) for continuation therapy.

Overall, 77.3% of the patients who received citalopram and 82.1% of patients receiving placebo completed 15 weeks of therapy. Citalopram was superior to placebo in reducing relapse rates based on all measures, but only significantly better than placebo when measured by the HAM-D₆ (17.1% vs. 33.7%, respectively) and MES scales (16.2% vs. 35.1%, respectively) (P < 0.05 for both).

These data suggest to the authors that "patients not inclined to extend light treatment over the season could use a shorter light treatment course and continue with an antidepressant drug."



Acta Psychiatr Scand 2004 Mar;109:3:230-4. "Relapse prevention by citalopram in SAD patients responding to 1 week of light therapy. A placebo-controlled study"

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