title: Citalopram treatment of social anxiety disorder with comorbid major depression.
abstract: Treatment of patients with both social anxiety disorder and major depression has been little studied although social anxiety disorder and depression frequently co-occur. Each disorder has been shown to respond to serotonin reuptake inhibitor treatment. Objectives of this study were to characterize a sample of these comorbid patients and to assess response to treatment with citalopram. Patients with primary DSM-IV generalized subtype of social anxiety disorder and comorbid major depression (N = 21) were assessed for symptoms of each disorder, including atypical depressive features, and functional impairment. Patients were treated with a flexible dose of open label citalopram for 12 weeks. Response rates for the intention-to-treat sample at week 12 were 14/21 (66.7%) for social anxiety disorder and 16/21 (76.2%) for depression. All continuous measures of social anxiety, depression, and functional impairment improved significantly with treatment, but depression symptoms responded more rapidly and more completely than social anxiety symptoms. Mean dose of citalopram at study endpoint was 37.6 mg/day. Only three patients (14.3%) fulfilled DSM-IV criteria for atypical features of depression, although 18 (85.7%) fulfilled the criterion for interpersonal rejection sensitivity. Citalopram treatment may benefit patients with primary social anxiety disorder and comorbid major depression, and it should be further studied in controlled trials. Improvement in social anxiety disorder symptoms lagged behind improvement in depression, and greater than 12 weeks of treatment may be required to assess full social anxiety response in patients with comorbid depression. The overlap of social anxiety disorder with atypical features of depression may primarily be due to the shared feature of rejection sensitivity.
authors.affiliation: Anxiety Disorders Clinic, New York State Psychiatric Institute, New York, New York 10032, USA. frs1@columbia.edu
authors.forename: Franklin R
authors.initials: FR
authors.lastname: Schneier
authors.forename: Carlos
authors.initials: C
authors.lastname: Blanco
authors.forename: Raphael
authors.initials: R
authors.lastname: Campeas
authors.forename: Roberto
authors.initials: R
authors.lastname: Lewis-Fernandez
authors.forename: Shu-Hsing
authors.initials: SH
authors.lastname: Lin
authors.forename: Randall
authors.initials: R
authors.lastname: Marshall
authors.forename: Andrew B
authors.initials: AB
authors.lastname: Schmidt
authors.forename: J Arturo
authors.initials: JA
authors.lastname: Sanchez-Lacay
authors.forename: H Blair
authors.initials: HB
authors.lastname: Simpson
authors.forename: Michael R
authors.initials: MR
authors.lastname: Liebowitz
mesh_terms: D000328:Adult; D000368:Aged; D015283:Citalopram / Q000627:therapeutic use*; D003865:Major Depressive Disorder / Q000150:complications* / Q000188:drug therapy*; D005260:Female; D006801:Humans; D008297:Male; D008875:Middle Aged; D010698:Phobic Disorders / Q000150:complications* / Q000175:diagnosis / Q000188:drug therapy*; D011446:Prospective Studies; D017367:Selective Serotonin Reuptake Inhibitors / Q000627:therapeutic use*; D012720:Severity of Illness Index
chemical_list: D015283:Citalopram; D017367:Selective Serotonin Reuptake Inhibitors