Intervention Review

Citalopram versus other anti-depressive agents for depression

  1. Andrea Cipriani1,*,
  2. Marianna Purgato1,
  3. Toshi A Furukawa2,
  4. Carlotta Trespidi1,
  5. Giuseppe Imperadore1,
  6. Alessandra Signoretti1,
  7. Rachel Churchill3,
  8. Norio Watanabe4,
  9. Corrado Barbui1

Editorial Group: Cochrane Depression, Anxiety and Neurosis Group

Published Online: 11 JUL 2012

Assessed as up-to-date: 1 FEB 2012

DOI: 10.1002/14651858.CD006534.pub2

How to Cite

Cipriani A, Purgato M, Furukawa TA, Trespidi C, Imperadore G, Signoretti A, Churchill R, Watanabe N, Barbui C. Citalopram versus other anti-depressive agents for depression. Cochrane Database of Systematic Reviews 2012, Issue 7. Art. No.: CD006534. DOI: 10.1002/14651858.CD006534.pub2.

Author Information

  1. 1

    University of Verona, Department of Public Health and Community Medicine, Section of Psychiatry, Verona, Italy

  2. 2

    Kyoto University Graduate School of Medicine / School of Public Health, Department of Health Promotion and Human Behavior, Kyoto, Japan

  3. 3

    University of Bristol, Academic Unit of Psychiatry, School of Social and Community Medicine, Bristol, UK

  4. 4

    Nagoya City University Graduate School of Medical Sciences, Department of Psychiatry & Cognitive-Behavioral Medicine, Nagoya, Aichi, Japan

*Andrea Cipriani, Department of Public Health and Community Medicine, Section of Psychiatry, University of Verona, Policlinico "G.B.Rossi", Piazzale L.A. Scuro, 10, Verona, 37134, Italy. andrea.cipriani@univr.it. andrea.cipriani@psych.ox.ac.uk.

Publication History

  1. Publication Status: New
  2. Published Online: 11 JUL 2012

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Abstract

  1. Top of page
  2. Abstract
  3. Plain language summary

Background

Recent US and UK clinical practice guidelines recommend that second-generation antidepressants should be considered amongst the best first-line options when drug therapy is indicated for a depressive episode. Systematic reviews have already highlighted some differences in efficacy between second-generation antidepressants. Citalopram, one of the first selective serotonin reuptake inhibitors (SSRI) introduced in the market, is one of these antidepressant drugs that clinicians use for routine depression care.

Objectives

To assess the evidence for the efficacy, acceptability and tolerability of citalopram in comparison with tricyclics, heterocyclics, other SSRIs and other conventional and non-conventional antidepressants in the acute-phase treatment of major depression.

Search methods

We searched The Cochrane Collaboration Depression, Anxiety and Neurosis Controlled Trials Register and the Cochrane Central Register of Controlled Trials up to February 2012. No language restriction was applied. We contacted pharmaceutical companies and experts in this field for supplemental data.

Selection criteria

Randomised controlled trials allocating patients with major depression to citalopram versus any other antidepressants.

Data collection and analysis

Two reviewers independently extracted data. Information extracted included study characteristics, participant characteristics, intervention details and outcome measures in terms of efficacy (the number of patients who responded or remitted), patient acceptability (the number of patients who failed to complete the study) and tolerability (side-effects).

Main results

Thirty-seven trials compared citalopram with other antidepressants (such as tricyclics, heterocyclics, SSRIs and other antidepressants, either conventional ones, such as mirtazapine, venlafaxine and reboxetine, or non-conventional, like hypericum). Citalopram was shown to be significantly less effective than escitalopram in achieving acute response (odds ratio (OR) 1.47, 95% confidence interval (CI) 1.08 to 2.02), but more effective than paroxetine (OR 0.65, 95% CI 0.44 to 0.96) and reboxetine (OR 0.63, 95% CI 0.43 to 0.91). Significantly fewer patients allocated to citalopram withdrew from trials due to adverse events compared with patients allocated to tricyclics (OR 0.54, 95% CI 0.38 to 0.78) and fewer patients allocated to citalopram reported at least one side effect than reboxetine or venlafaxine (OR 0.64, 95% CI 0.42 to 0.97 and OR 0.46, 95% CI 0.24 to 0.88, respectively).

Authors' conclusions

Some statistically significant differences between citalopram and other antidepressants for the acute phase treatment of major depression were found in terms of efficacy, tolerability and acceptability. Citalopram was more efficacious than paroxetine and reboxetine and more acceptable than tricyclics, reboxetine and venlafaxine, however, it seemed to be less efficacious than escitalopram. As with most systematic reviews in psychopharmacology, the potential for overestimation of treatment effect due to sponsorship bias and publication bias should be borne in mind when interpreting review findings. Economic analyses were not reported in the included studies, however, cost effectiveness information is needed in the field of antidepressant trials.

 

Plain language summary

  1. Top of page
  2. Abstract
  3. Plain language summary

Citalopram versus other antidepressants for depression

Major depression is a severe mental illness characterised by a persistent and unreactive low mood and loss of all interest and pleasure, usually accompanied by a range of symptoms including appetite change, sleep disturbance, fatigue, loss of energy, poor concentration, psychomotor symptoms, inappropriate guilt and morbid thoughts of death. Antidepressant drugs remain the mainstay of treatment in moderate-to-severe major depression. During the last 20 years, selective serotonin reuptake inhibitors (SSRIs) have progressively become the most commonly prescribed antidepressants. Citalopram, one of the first SSRIs introduced in the market, is the racemic mixture of S- and R-enantiomer. In the present review we assessed the evidence for the efficacy, acceptability and tolerability of citalopram in comparison with all other antidepressants in the acute-phase treatment of major depression. Thirty-seven randomised controlled trials (more than 6000 participants) were included in the present review. In terms of efficacy, citalopram was more efficacious than other reference compounds like paroxetine or reboxetine, but worse than escitalopram. In terms of side effects, citalopram was more acceptable than older antidepressants, like tricyclics. Based on these findings, we conclude that clinicians should focus on practical or clinically relevant considerations including differences in efficacy and side-effect profiles.