Comparison of Placebo, Citalopram, and Sertraline in Major Depression
ABSTRACT & COMMENTARY
Source: Stahl SM. Placebo-controlled comparison of the selective serotonin reuptake inhibitors citalopram and sertraline. Biol Psychiatry 2000;48:894-901.
The current study is relatively rare in that it includes two active comparators and a placebo control group for the treatment of depression. Three hundred twenty-three patients with major depressive disorder were randomized to 24 weeks of double-blind treatment with citalopram (Celexa) (20-60 mg/d), sertraline (Zoloft) (50-150 mg/d), or placebo. Assessments included the Hamilton Depression Rating Scale (HAMD), the Montgomery-Asberg Depression Rating Scale (MADRS), the Hamilton Anxiety Scale, and the Clinical Global Impression Scale. Both citalopram and sertraline produced significantly greater improvement than placebo on each of the measures of depression. Significant improvement was observed at earlier time points in the citalopram group than the sertraline group. However, more patients discontinued sertraline due to adverse events, which may have decreased the mean improvement in an intent-to-treat analysis. The Hamilton Anxiety Scale demonstrated a significant improvement in the citalopram treated group compared to both the sertraline and placebo groups. Adverse events during the 24 weeks of the study led to withdrawal from the study of 15 (14%) of the citalopram group, 21 (19%) of the sertraline group, and 11 (10%) of the placebo group. More patients discontinued for adverse events in the first eight weeks from the sertraline group (15%) compared with citalopram and placebo (8% and 7%, respectively). Nausea, somnolence, ejaculation disorder (male patients), increased sweating, anorexia, and decreased libido occurred significantly more frequently in both active treatment groups vs. placebo, with the exception of nausea, which occurred significantly more frequently in sertraline patients only. The majority of adverse events were mild or moderate in severity for all treatment groups.
COMMENT BY LAUREN B. MARANGELL, MD
SSRIs available in the United States include citalopram (Celexa), fluoxetine (Prozac), fluvoxamine (Luvox), sertraline (Zoloft), and paroxetine (Paxil). While there are many studies demonstrating the effectiveness and tolerability of SSRIs compared to other classes of antidepressant medications, in particular tricyclic antidepressants, few head to head comparisons exist, particularly with the inclusion of placebo. Although the current study requires replication, the possible difference in anxiolytic effects is of potential import given the high occurrence of anxiety symptoms in patients with depression.
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