Efficacy of intravenous citalopram compared with oral citalopram for severe depression - Safety and efficacy data from a double-blind, double-dummy trial

Background: Intravenous administration is often beneficial in the treatment of severely depressed patients. It is mainly the tri- and tetracyclic anti depressant drugs that can be administered intravenously, However, these dru gs have a less favourable safety profile than newer antidepressants, such a s the selective serotonin reuptake inhibitors (SSRIs). Citalopram is the on ly SSRI that is available in a formulation for infusion. This double-blind, randomised, multicentre trial was designed to compare the efficacy and tol erability of citalopram infusion (40 mg per day) and citalopram tablet (40 mg per day). Methods: Patients were randomised to receive either placebo ta blet plus citalopram infusion (the infusion group; n = 135) or citalopram t ablet plus placebo infusion (the tablet group; n = 119). After receiving ra ndomised treatment for eight days, all patients entered an open treatment p hase, during which they received oral citalopram 40 mg per day for five wee ks. Results: Although there was no difference in Montgomery-Asberg Depressi on Rating Scale (MADRS) scores at the end of the randomised treatment perio d, by the end of the open treatment phase the reduction in MADRS scores was significantly greater in the infusion group than in the tablet group (p = 0.015). The infusion group also showed superior efficacy in Clinical Global Impressions assessments. Citalopram was equally well tolerated in both tre atment groups. Conclusions: This trial confirmed the efficacy of citalopram 40 mg per day, and clearly supports the use of citalopram infusion in the treatment of severely depressed, hospitalised patients. (C) 2000 Elsevier S cience B.V. All rights reserved.