Placebo-controlled comparison of the selective serotonin reuptake inhibitors citalopram and sertraline

Background: Previous comparative studies of the selective serotonin reuptak e inhibitors (SSRIs) have rarely included a placebo control group and have rarely demonstrated significant between-group differences, The study report ed on here was a placebo-controlled comparison of the antidepressant effect s of two SSRIs, citalopram and sertraline. Methods: Three hundred twenty-three patients with DSM-IV-defined major depr essive disorder were randomized to 24 weeks of double-blind treatment with citalopram (20-60 mg/day), sertraline (50-150 mg/day), or a placebo. The pr imary efficacy measure was the Hamilton Depression Rating Scale (HAMD) and the primary statistical analysis was an analysis of variance comparing the change from baseline to the last observation carried forward in each treatm ent group. Results: Both citalopram and sertraline produced significantly greater impr ovement than placebo on the HAMD the Montgomery-Asberg Depression Rating Sc ale, and the Clinical Global Impression Scale. Significant improvement was observed at earlier timepoints in the citalopram group than the sertraline group; however, sertraline treatment was associated with increased gastroin testinal side effects and a tendency toward early discontinuation, and anal yses that excluded early dropouts revealed similar acute efficacy far the t wo active treatments. The Hamilton Anxiety Scale demonstrated a significant anxiolytic effect of citalopram, but not sertraline, relative to placebo. Conclusions: This study confirms the antidepressant efficacy of two SSRIs, citalopram and sertraline. It is hypothesized that the more consistent evid ence of antidepressant activity that was observed early in treatment in the citalopram group was related to more pronounced anti-anxiety effects and b etter tolerability upon initiation of therapy, (C) 2000 Society of Biologic al Psychiatry.