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Citalopram (Celexa) versus Other

Citalopram vs. Reboxetine
  • Panic disorder:
    Both citalopram and reboxetine significantly improve panic attack severity. However, Citalopram appears to have superior efficacy in treating comorbid depressive symptoms 1.
  • Pain disorder:
    In the 8-week, randomized double-blind study, patients with a DSM-IV-TR diagnosis of Pain Disorder were randomly assigned to receive either citalopram 40 mg/day or reboxetine 8 mg/day. In the citalopram group, Present Pain Intensity (PPI) and Total Pain Rating Index (tPRI) scores measured at baseline decreased after treatment (tPRI: 41.9 vs. 30.0; PPI: 3.5 vs. 2.8) whereas in the reboxetine group differences were not statistically significant (tPRI: 35.2 vs. 31.5; PPI: 3.7 vs. 3.1).
    The results of the study suggests that the SSRI citalopram may have a moderate analgesic effect in patients with Pain Disorder. This analgesic activity appears to be not correlated to changes in depressive scores 3.
Citalopram vs. Fluoxetine (Prozac)
  • Major depressive disorder: Citalopram is as effective as fluoxetine in the treatment of unipolar major depression. In the study citalopram showed an earlier onset of recovery than fluoxetine 8.
  • Bulimia nervosa: In the study patients treated with fluoxetine displayed a greater reduction in introjected anger, whereas those treated with citalopram displayed a greater reduction in depressive feelings. Citalopram may be useful in depressed patients with bulimia, whereas fluoxetine is more specific for those with introjected anger and bulimia 2.

Citalopram vs. Paroxatine (Paxil)

Panic disorder: Paroxetine and citalopram have similar anti-panic properties and a good tolerability profile 5.

Citalopram vs. Sertraline (Zoloft)
  • Efficacy:
    Major depressive disorder: Sertraline and citaloptam have similar efficacy in the treatment of major depression. However, citalopram has more pronounced antianxiety effects 11, 12.
  • Side effects: Sertraline treatment is associated with higher rate of gastrointestinal side effects 12. Sertraline is associated with lower incidence of weight gain and sexual side effects than citalopram 13, 14.

Citalopram vs. Escitalopram (Lexapro)
  • Escitalopram appears to have greater efficacy and faster onset of action than comparable doses of citalopram. The lower efficacy of citalopram in the studies is apparently due to the inhibition of the effect of the S-enantiomer by the R-enantiomer. Data from randomised clinical trials consistently show better efficacy with escitalopram than with citalopram, including higher rates of response and remission, and faster time to symptom relief 6.
  • Major depressive disorder: Escitalopram may be a cost-saving alternative to citalopram for the treatment of severe depression 7. Escitalopram may have a faster onset and greater overall magnitude of effect than citalopram in improving symptoms of depression and anxiety in patients with major depressive disorder 10. Escitalopram has better efficacy in the treatment of severe depression than citalopram 15.
  • Antinociceptive properties: Study findings show that citalopram given i.p. is a weak antinociceptor, (not mediated through opioid mechanisms), while escitalopram possesses no antinociceptive properties when injected i.p. 9.

Citalopram vs. Nortriptyline
  • Efficacy:
    Major depressive disorder: A comparative study demonstrated significantly higher remission rate to nortriptyline than to citalopram in moderate to severe major depressive patients, especially if severe patients (endogenous or psychotic patients) were assessed 16.
  • Side effects: Citalopram appears to be better tolerated than nortriptyline. Autonomic side effects are significantly higher for nortriptyline than for citalopram 16.

Citalopram vs. Amitriptyline
  • Efficacy:
    • Comorbidity of depression, migraine, and tension-type headache: Amitriptyline and citalopram are equally efficacious in relieving depressive symptoms. However, amitriptyline appears to be more efficacious than citalopram in reducing migraine and tension-type headache attacks 17.
      Combined therapy with amitriptyline and citalopram may be particularly beneficial for individuals with tension-type headache, migraine and comorbid depression that do not respond to monotherapy.
    • Chronic tension-type headache: Amitriptyline can significantly reduce the duration of headache, headache frequency, and intake of analgesics, whereas citalopram has no significant effect 12.
    • Depression: Both drugs are effective, and citalopram is probably as efficacious as amitriptyline. However, amitriptyline may have a better effect on sleep disturbances due to its more hypnotic effect 19, 20.
  • Side effects: Amitriptyline produces side effects more frequently than citalopram 19, 20.

Citalopram vs. Mirtazapine (Remeron)
  • Efficacy:
    Major depressive disorder: Mirtazapine has potentially faster onset of efficacy than citalopram.
    In the study, mirtazapine and citalopram were equally effective in reducing symptoms of depression and anxiety. However, mirtazapine was significantly more effective than citalopram after 2 weeks of treatment on the several Severity of illness and Quality of life scales (MADRS, HAM-A and CGI ) 4.
  • Side effects: Sweating and nausea are associated significantly more frequently with citalopram treatment, whereas increased appetite and complaints of weight increase with mirtazapine treatment 4.

Further reading
References
  • 1. Seedat S, van Rheede van Oudtshoorn E, Muller JE, Mohr N, Stein DJ. Reboxetine and citalopram in panic disorder: a single-blind, cross-over, flexible-dose pilot study. Int Clin Psychopharmacol. 2003 Sep;18(5):279-84. PubMed
  • 2. Leombruni P, Amianto F, Delsedime N, Gramaglia C, Abbate-Daga G, Fassino S. Citalopram versus fluoxetine for the treatment of patients with bulimia nervosa: a single-blind randomized controlled trial. Adv Ther. 2006 May-Jun;23(3):481-94. PubMed
  • 3. Aragona M, Bancheri L, Perinelli D, Tarsitani L, Pizzimenti A, Conte A, Inghilleri M. Randomized double-blind comparison of serotonergic (Citalopram) versus noradrenergic (Reboxetine) reuptake inhibitors in outpatients with somatoform, DSM-IV-TR pain disorder. Eur J Pain. 2005 Feb;9(1):33-8. PubMed
  • 4. Leinonen E, Skarstein J, Behnke K, Agren H, Helsdingen JT. Efficacy and tolerability of mirtazapine versus citalopram: a double-blind, randomized study in patients with major depressive disorder. Nordic Antidepressant Study Group. Int Clin Psychopharmacol. 1999 Nov;14(6):329-37. PubMed
  • 5. Perna G, Bertani A, Caldirola D, Smeraldi E, Bellodi L. A comparison of citalopram and paroxetine in the treatment of panic disorder: a randomized, single-blind study. Pharmacopsychiatry. 2001 May;34(3):85-90. PubMed
  • 6. Sanchez C, B?ges? KP, Ebert B, Reines EH, Braestrup C. Escitalopram versus citalopram: the surprising role of the R-enantiomer. Psychopharmacology (Berl). 2004 Jul;174(2):163-76. PubMed
  • 7. Wade AG, Toumi I, Hemels ME. A pharmacoeconomic evaluation of escitalopram versus citalopram in the treatment of severe depression in the United Kingdom. Clin Ther. 2005 Apr;27(4):486-96. PubMed
  • 8. Patris M, Bouchard JM, Bougerol T, Charbonnier JF, Chevalier JF, Clerc G, Cyran C, Van Amerongen P, Lemming O, Hopfner Petersen HE. Citalopram versus fluoxetine: a double-blind, controlled, multicentre, phase III trial in patients with unipolar major depression treated in general practice. Int Clin Psychopharmacol. 1996 Jun;11(2):129-36. PubMed
  • 9. Schreiber S, Pick CG. From selective to highly selective SSRIs: a comparison of the antinociceptive properties of fluoxetine, fluvoxamine, citalopram and escitalopram. Eur Neuropsychopharmacol. 2006 Aug;16(6):464-8. Epub 2006 Jan 18. PubMed
  • 10. Moore N, Verdoux H, Fantino B. Prospective, multicentre, randomized, double-blind study of the efficacy of escitalopram versus citalopram in outpatient treatment of major depressive disorder. Int Clin Psychopharmacol. 2005 May;20(3):131-7. PubMed
  • 11. Ekselius L, von Knorring L, Eberhard G. A double-blind multicenter trial comparing sertraline and citalopram in patients with major depression treated in general practice. Int Clin Psychopharmacol. 1997 Nov;12(6):323-31. PubMed
  • 12. Stahl SM. Placebo-controlled comparison of the selective serotonin reuptake inhibitors citalopram and sertraline. Biol Psychiatry. 2000 Nov 1;48(9):894-901. PubMed
  • 13. Meijer WE, Heerdink ER, van Eijk JT, Leufkens HG. Adverse events in users of sertraline: results from an observational study in psychiatric practice in The Netherlands. Pharmacoepidemiol Drug Saf. 2002;11:65562. PubMed
  • 14. Montejo AL, Llorca G, Izquierdo JA, Rico-Villademoros F. Incidence of sexual dysfunction associated with antidepressant agents: a prospective multicenter study of 1022 outpatients. Spanish Working Group for the Study of Psychotropic-Related Sexual Dysfunction. J Clin Psychiatry. 2001;62 Suppl 3:10-21. PubMed
  • 15. Azorin JM, Llorca PM, Despiegel N, Verpillat P. Escitalopram is more effective than citalopram for the treatment of severe major depressive disorder. Encephale. 2004 Mar-Apr;30(2):158-66.
  • 16. Navarro V, Gasto' C, Torres X, Marcos T, Pintor L. Citalopram versus nortriptyline in late-life depression: a 12-week randomized single-blind study. Acta Psychiatr Scand. 2001 Jun;103(6):435-40. PubMed
  • 17. Rampello L, Alvano A, Chiechio S, Malaguarnera M, Raffaele R, Vecchio I, Nicoletti F. Evaluation of the prophylactic efficacy of amitriptyline and citalopram, alone or in combination, in patients with comorbidity of depression, migraine, and tension-type headache. Neuropsychobiology. 2004;50(4):322-8. PubMed
  • 18. Bendtsen L, Jensen R, Olesen J. A non-selective (amitriptyline), but not a selective (citalopram), serotonin reuptake inhibitor is effective in the prophylactic treatment of chronic tension-type headache. J Neurol Neurosurg Psychiatry. 1996 Sep;61(3):285-90. PubMed
  • 19. Gravem A, Amthor KF, Astrup C, Elgen K, Gjessing LR, Gunby B, Pettersen RD, Kyrdalen L, Vaadal J, Ofsti E, et al. A double-blind comparison of citalopram (Lu 10-171) and amitriptyline in depressed patients. Acta Psychiatr Scand. 1987 May;75(5):478-86. PubMed
  • 20. Shaw DM, Thomas DR, Briscoe MH, Watkins SE, Crimmins R, Harris B, Lovett J, Raj M, Lloyd AT, Osborne C, et al. A comparison of the antidepressant action of citalopram and amitriptyline. Br J Psychiatry. 1986 Oct;149:515-7. PubMed

Published: March 31, 2008
Last updated: April 25, 2011

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