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Citalopram, a popular antidepressant in Europe, has been approved for the treatment of depression in the United States, making it the fourth SSRI available to American physicians for treating depression. The other three are fluoxetine, sertraline, and paroxetine.
The drug, which was developed by the Danish pharmaceutical firm H. Lundbeck A/S, is marketed under the brand name Celexa by Forest Laboratories Inc. and Parke-Davis in the United States. It was granted FDA approval in July.
The drug has been proven effective and was well tolerated in clinical trials involving more than 23,000 patients and in clinical use in which more than 8 million people worldwide were treated with the medication over the course of a decade, according to a press statement by the drug manufacturers.
"Citalopram has some unique properties, including a very low rate of interactions with other medications and a low incidence of associated anxiety and agitation when treatment is initiated. The SSRI works well with most patients, which I can confirm based on my clinical experience," said Jack Gorman, M.D., a professor of psychiatry at Columbia University College of Physicians and Surgeons in New York City and a consultant to Forest Laboratories Inc. and Parke-Davis.
Gorman added, "Studies in Europe, where the drug has been approved for clinical use since 1989, show that it is especially well tolerated among the elderly."
The most commonly reported side effects in clinical trials were nausea, dry mouth, and sleepiness, according to the press statement. Citalopram, like other SSRIs, should not be taken with monoamine oxidase inhibitors.
Roger Peele, M.D., chair of APA's Council on Psychiatric Services, commented to Psychiatric News, "I welcome having an additional option in the same class of medications because one SSRI may work better than another for a given patient."
Data from an eight-week trial in France also suggest that patients with unipolar major depression taking citalopram show greater improvement at two weeks than patients taking fluoxetine. However, Gorman cautioned against discontinuing the drug if it doesn't work in two weeks.
Lawrence Olanoff, M.D., Ph.D., vice president for science affairs of Forest Laboratories Inc. in New York City, told Psychiatric News that the preliminary results of a 24-week study comparing sertraline, citalopram, and placebo showed that the citalopram group had a significantly greater therapeutic response than the sertraline group by the second week of double-blind treatment. Olanoff noted that this finding was consistent with the results of European studies.
Charles Flicker, Ph.D., senior medical director of Forest Laboratories Inc., told Psychiatric News that a double-blind, multisite trial comparing citalopram and placebo in geriatric patients with major depression is under way.
"Because of citalopram's good safety profile and its positive effects on behavioral disturbances in Alzheimer's patients, geriatric psychiatrists approached us to study citalopram in this population," said Flicker.
Other planned studies will focus on citalopram's potential efficacy in the treatment of bipolar illness, depression in children and adolescents, obsessive-compulsive disorder, and panic disorder, according to Flicker.
The recommended starting dosage is 20 mg daily, and the therapeutic dosage range is from 20 to 60 mg daily. A dosage of 20 mg to 40 mg daily is recommended for elderly patients or patients with impaired liver function, according to a fact-sheet on Celexa.
In the United States, Celexa costs slightly less than the other SSRIs, and about 8 percent to 10 percent less than the lowest-priced SSRI, according to Olanoff.
More information on citalopram will be available at the Web site www.celexa.com, which is sponsored by the drug companies marketing citalopram.