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Evidence summaries

Citalopram for Depression

Citalopram appears to be more efficacious than paroxetine and reboxetine and more acceptable than tricyclics, reboxetine and venlafaxine, but it appears to be less efficacious than escitalopram in major depression. Level of evidence: "B"

A Cochrane review [Abstract] 1 included 37 studies. The 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, in patients with major depression. Citalopram was shown to be significantly less effective than escitalopram in achieving acute response (OR 1.47, 95% CI 1.08 to 2.02; 6 trials, n=1806), but more effective than paroxetine (OR 0.65, 95% CI 0.44 to 0.96; 1 trial, n=406) and reboxetine (OR 0.63, 95% CI 0.43 to 0.91; 2 trials, n=458). 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; 8 studies, n=1216) 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; 1 trial, n=357 and OR 0.46, 95% CI 0.24 to 0.88; 1 trial, n=151, respectively).

Comment: The quality of evidence is downgraded by study quality (unclear allocation concealment)

References

  • Cipriani A, Purgato M, Furukawa TA et al. Citalopram versus other anti-depressive agents for depression. Cochrane Database Syst Rev 2012;7():CD006534. [PubMed]

Primary/Secondary Keywords