Citalopram in the treatment of depression.
OBJECTIVE
To review the efficacy and safety of citalopram in the treatment of depression.


METHODS
MEDLINE search (1966-April 2000), Current Contents search, additional references listed in articles, and unpublished data obtained from the manufacturer were used to identify data from scientific literature. Studies evaluating citalopram (i.e., abstracts, clinical trials, data on file with the manufacturer) were considered for inclusion.


METHODS
English-language literature was reviewed to evaluate the pharmacology, pharmacokinetics, therapeutic use, and adverse effects of citalopram.


METHODS
Controlled animal and human clinical studies published in the English-language literature were reviewed and evaluated. Clinical trials selected for inclusion were limited to those in human subjects and included data from animals if human data were not available.


RESULTS
Citalopram is an antidepressant belonging to the class of selective serotonin-reuptake inhibitors (SSRIs) available for the treatment of depression. Citalopram offers therapeutic efficacy similar to that of the other SSRIs and a more favorable adverse effect profile than that of the tricyclic antidepressants (TCAs). Citalopram does not cause anticholinergic or cardiovascular adverse effects associated with the TCAs. Citalopram is the most selective SSRI and, unlike other SSRIs, seems to be relatively free of interaction mediated by the cytochrome P450 system. Citalopram is also the least expensive antidepressant available to date. This review of citalopram includes data from clinical trials comparing safety, tolerability, efficacy, and pharmacoeconomics with TCAs and SSRIs.


CONCLUSIONS
Clinical trials demonstrate that citalopram's therapeutic efficacy is significantly greater than that of placebo and is comparable with that of other antidepressants. Citalopram has a favorable adverse effect profile, and thus may be useful in treating depressed patients who cannot tolerate anticholinergic or cardiovascular adverse effects associated with TCAs. It may also be useful in patients with comorbid illnesses requiring concomitant medicines.
Parker
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College of Pharmacy, University of Tennessee at Memphis 38163, USA. Nparker@utmem.edu
Brown
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CS
D000929:Antidepressive Agents, Tricyclic / Q000493:pharmacokinetics / Q000627:therapeutic use; D015283:Citalopram / Q000737:chemistry / Q000493:pharmacokinetics / Q000627:therapeutic use*; D018849:Controlled Clinical Trials as Topic; D003577:Cytochrome P-450 Enzyme System / Q000187:drug effects / Q000378:metabolism; D003866:Depressive Disorder / Q000188:drug therapy*; D004347:Drug Interactions; D006801:Humans; D017367:Selective Serotonin Reuptake Inhibitors / Q000737:chemistry / Q000493:pharmacokinetics / Q000627:therapeutic use*
D000929:Antidepressive Agents, Tricyclic; D015283:Citalopram; D003577:Cytochrome P-450 Enzyme System; D017367:Selective Serotonin Reuptake Inhibitors