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Citalopram (Celexa) versus ...

Citalopram vs Reboxetine

Depression

Reboxetine may be more effective than citalopram in treating depression with high levels of fatigue 2.

Results of double-blind study comparing reboxetine with citalopram in major depressive disorder 1.
Citalopram
Reboxetine
Regimen 20-40 mg per day during 24 weeks 8-10 mg per day during 24 weeks
Reduction of HAM-D scores
-22.1 points,
greater reduction of the HAM-D scores
-21.4 points
Response rate
92.7%
90.3%
Most common side effect sexual dysfunction dry mouth
Anorgasmia rate in sexually active women at week 24
39%
5.9%
Dropout, number of patients
54
91

Pain disorder

Results of randomized double-blind comparison of citalopram versus reboxetine in outpatients with somatoform pain disorder. 3.
Citalopram
Reboxetine
Regimen 40 mg/day (N=17 patients) 8 mg/day (N=18 patients)
Present Pain Intensity (PPI) scores at baseline and after treatment
3.5 vs. 2.8
3.7 vs. 3.1
Total Pain Rating Index (tPRI) scores at baseline and after treatment
41.9 vs. 30.0
35.2 vs. 31.5

Panic disorder

Results of single-blind, cross-over, flexible-dose pilot study of reboxetine and citalopram in panic disorder4.
Citalopram
Reboxetine
Response rate at week 18 9 of 11 patients (82%) 7 of 13 patients (54%)
  1 non-responder to citalopram responded to reboxetine.
3 non-responders to reboxetine responded to citalopram.

Citalopram vs Nortriptyline

Depression

Results of randomized single-blind study of citalopram versus nortriptyline in late-life depression 5.
Citalopram
Nortriptyline
Number of drop-outs
similar
Autonomic side-effects citalopram is better tolerated
significantly higher
Remission rate  
significantly higher, particularly in endogenous or psychotic patients

Citalopram vs Amitriptyline

Depression

Both antidepressants are effective in major depression. However, amitriptyline has a better effect on sleep disturbances due to its more hypnotic effect 7.

Results of comparison of citalopram versus amitriptyline in the treatment of major depression 6.
Citalopram
Amitriptyline
Percentage reduction on the Hamilton Depression Rating Scale
72.12%
67.93%
Percentage reduction at the end of the study on the CGI-Improvement Scale
56.79%
44.70%
Adverse effects rate
20%
75%

Results of comparison of the tolerability and efficacy of citalopram and amitriptyline in elderly depressed patients 8.
Citalopram
Amitriptyline
Regimen 20 or 40 mg/day 50 or 100 mg/day
Time-related declines in severity of depression
equivalent,
by 8 weeks slightly more than 50% of the patients in each antidepressant group experienced marked recovery
Dry mouth, rate 7% 34%
Nausea 12.8% 4.8%
Somnolence, constipation, fatigue   more frequently

Citalopram vs Mirtazapine (Remeron)

Depression

Mirtazapine and citalopram are equally effective in reducing symptoms of depression and anxiety. However, mirtazapine was significantly more effective than citalopram after 2 weeks of treatment on the MADRS, HAM-A and CGI Severity of illness and Quality of life scales 10. Mirtazapine may provide faster improvement of sleep, quality of sleep and improved alertness following awakening.

Results of a double-blind, randomized study of mirtazapine versus citalopram in patients with major depressive disorder10.
Citalopram
Mirtazapine
Mean MADRS scores after 8 weeks 9.1 8.9
Percentage of patients prematurely terminated the study 3% 3.6%
Most frequent side effects sweating and nausea increased appetite and complaints of weight increase

Further reading
References
  • 1. Langworth S, Bodlund O, Agren H. Efficacy and tolerability of reboxetine compared with citalopram: a double-blind study in patients with major depressive disorder. J Clin Psychopharmacol. 2006 Apr;26(2):121-7. PubMed
  • 2. Bould H, Wiles N, Potokar J, Cowen P, Nutt DJ, Peters TJ, Lewis G. Does baseline fatigue influence treatment response to reboxetine or citalopram in depression? An open label randomized controlled trial. J Psychopharmacol. 2012 May;26(5):663-9. 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. 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
  • 5. 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
  • 6. Mathur A, Sharma DK, Choudhary A, Jain M. Efficacy and safety of citalopram versus amitriptyline in the treatment of major depression. Indian J Psychiatry. 2005 Apr;47(2):89-93. PubMed
  • 7. 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
  • 8. Kyle CJ, Petersen HE, Overø KF. Comparison of the tolerability and efficacy of citalopram and amitriptyline in elderly depressed patients treated in general practice. Depress Anxiety. 1998;8(4):147-53. PubMed
  • 9. 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
  • 10. 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. Int Clin Psychopharmacol. 1999 Nov;14(6):329-37. PubMed

Published: March 31, 2008
Last updated: July 28, 2014

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