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Prophylactic effect of citalopram in unipolar, recurrent depression

Placebo-controlled study of maintenance therapy

Privatklinik, Meiringen, Switzerland

P.M. ISAKSEN, MD

Haukeland sykehus, Psykiatrisk klinikk, Bergen, Norway

H. KOPONEN, PhD

Department of Geropsychiatry, Moisio Hospital, Mikkeli, Finland

L. LAURITZEN, MD

Hillerød Hospital, Psykiatrisk afd. P, Hillerød, Denmark

F.A. MAHNERT, MD

Universitätsklinik für Psychiatrie, Graz, Austria

F. ROUILLON, MD

Service de Psychiatrie Hôpital Albert Chenevier, Creteil, France

A.G. WADE, MD

Community Pharmacology Services Ltd, Glasgow, UK

M. ANDERSEN, MSc, S.F. PEDERSEN, MSc, J.C.G. DE SWART, MSc and R. NIL, PhD

International Clinical Research, H. Lundbeck A/S, Valby, Denmark

Correspondence: B. Hochstrasser, Privatklinik, CH-3860 Meiringen, Switzerland

Declaration of interest Funded by H.Lundbeck A/S.

See editorial, pp. 294–295, this issue.

Background Major depression is highly recurrent. Antidepressant maintenance treatment has proven efficacy against recurrent depression.

Aims Comparison of prophylactic efficacy of citalopram versus placebo in unipolar, recurrent depression.

Methods Patients 18-65 years of age with recurrent unipolar major depression (DSM-IV), a Montgomery—sberg Depression Rating Scale score of 22 and two or more previous depressive episodes, one within the past 5 years, were treated openly with citalopram (20-60 mg) for 6-9 weeks and, if responding, continued for 16 weeks before being randomised to double-blind maintenance treatment with citalopram or placebo for 48-77 weeks.

Results A total of 427 patients entered acute treatment and 269 were randomised to double-blind treatment. Time to recurrence was longer in patients taking citalopram than in patients taking placebo (P<0.001). Prophylactic treatment was well tolerated.

Conclusions Citalopram (20, 40 and 60 mg) is effective in the prevention of depressive recurrences. Patients at risk should continue maintenance treatment at the dose necessary to resolve symptoms in the acute treatment phase.

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