Efficacy and safety of citalopram versus amitriptyline in the treatment of major depression

Abstract

Background: Double-blind clinical trials comparing citalopram with amitriptyline or other tricyclic antidepressants are lacking in India.

Aim: To evaluate the efficacy and safety of the newer antidepressant citalopram in the treatment of major depression.

Methods: The clinical acceptability and safety profile of citalopram was assessed and compared with that of amitriptyline in 40 patients in an outpatient set-up. Patients aged 18 to 65 years who fulfilled the diagnostic criteria for a single or recurrent major depressive disorder (as defined by DSM-IV) for a minimum of 2 weeks were enrolled. Patient assessment was done at screening, baseline, end of week 1, week 2, week 3, week 4, week 5 and week 6 for efficacy and safety parameters such as Hamilton Depression Rating Scale (HDRS), Clinical Global Impression (CGI) Scale, adverse event follow up, blood pressure and pulse. Three-level statistical analysis including ANOVA was performed on all efficacy measures.

Results: On the HDRS the percentage reduction in the mean score for the citalopram group (Group 1) was 72.12%, while that for the amitriptyline group (Group 2) was 67.93%. On the CGI-Improvement Scale, the percentage reduction at the end of the study for the citalopram group was 56.79% while in the amitriptyline group it was 44.70%. Twenty per cent of patients in Group 1 reported adverse events compared to 75% in Group 2.

Conclusions: Citalopram is effective in the treatment of major depression at the dosages range of 20-60 mg/day and its efficacy is equivalent to that of standard tricyclic antidepressants such as amitriptyline, with a substantially better tolerability profile.

Keywords: Major depression; SSRIs; side-effects; tricyclic antidepressants.

Fig. 1

HDRS mean total score for Group 1 (citalopram) and Group 2 (amitriptyline) patients

Fig. 2

CGI mean scores for Group 1 (citalopram) and Group 2 (amitriptyline) patients

Fig. 3

Overall assessment of tolerability by the investigator at the end of the 6-week study (assessments were based on the number and severity of side-effects and likelihood of a causal relationship).

Fig. 4

Overall assessment of tolerability by the patient at the end of the 6-week study (assessments were based on the number and severity of side-effects and likelihood of a causal relationship).

Fig. 5

Overall assessment of treatment acceptability at the end of the 6-week study