Citalopram versus other antidepressants for late-life depression: a systematic review and meta-analysis.
ABSTRACT To determine the efficacy and tolerability of citalopram when compared to other antidepressants for late-life depression (LLD).
We searched electronic databases and trial registries to identify randomized controlled trials comparing citalopram to other antidepressants for LLD. Study quality was assessed using the Cochrane collaboration risk of bias tool. We summarized the efficacy of citalopram compared to other antidepressants by examining rates of depression remission, depression response and change in depression symptom scores. Medication tolerability was assessed through trial withdrawals due adverse events and withdrawals due to any cause. We used meta-analysis to determine the odds ratios (OR) of efficacy and tolerability outcomes for citalopram compared to other antidepressants.
Seven studies comparing citalopram (N = 647) to other antidepressants (N = 641) for LLD were identified including four studies with tricyclic comparators and three studies with non-tricyclic comparators. Most of the studies had methodological limitations that placed them at risk for potential bias. The majority of studies reported no significant differences between citalopram and comparator medications for depression efficacy or tolerability outcomes. Meta-analysis did not find any significant differences between citalopram and other antidepressants for depression remission [OR = 0.84; 95%CI: 0.56-1.28] or for trial withdrawals due to adverse effects [OR = 0.70; 95%CI: 0.48-1.02].
Currently there are few studies directly comparing citalopram to other antidepressants for LLD. The small number of studies and methodological issues in many studies limit any conclusions about the relative efficacy and tolerability of citalopram compared to other antidepressants. Well-designed studies comparing citalopram to other antidepressants for LLD are required.
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ABSTRACT: New-generation antidepressants are a heterogeneous class of drugs used in the treatment of depression and related disorders. This review deals with the first new-generation antidepressant class to enter the pharmaceutical market, i.e., selective serotonin reuptake inhibitors (SSRIs), which are still the most prescribed and widely used ones. Their common characteristics are the comparable clinical efficacy, good tolerability and relative safety in comparison to "first generation antidepressants", i.e. classic tricyclic antidepressants and monoamine oxidase inhibitors. This class of drugs includes fluoxetine, citalopram, paroxetine, sertraline, fluvoxamine and, since 2011, vilazodone. In this review, the main pharmacodynamic and pharmacokinetic properties of the six commercially available SSRIs are described, focusing on side and toxic effects, chemical-clinical correlations, interactions with other drugs, the role of therapeutic drug monitoring (TDM) and related bioanalytical methodologies.Current Medicinal Chemistry 03/2012; 19(12):1846-63. · 3.72 Impact Factor
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ABSTRACT: Mood disorders are common and often under-recognised in older people whereby, together with the general ageing of the population, they are becoming a significant and growing public health problem worldwide. However, the need to address the problem of late life mood disorders in a real-world setting is met with a surprising lack of strong evidence in this field. Randomised clinical trials which focus on elderly mood disorders are not very common and the majority of them focus on pharmacological treatment of major depression. The aim of this study was to review first the main unmet needs and research challenges in late-life mood disorders as a basis to then review the state of the art evidence resulting from randomised clinical trials and the main critical aspects of their implementation. Comorbidity as well as polypharmacy, cognitive decline, unpredictable placebo response, and uncertainty on optimal duration of trials are some of the challenges the investigator has to address. Moreover, some methodological limitations of randomised clinical trials reduce the applicability of the results of such studies to common clinical practices and have encouraged some authors to investigate the existence of possible alternative research designs such as pragmatic randomised clinical trials.Aging - Clinical and Experimental Research 09/2013; · 1.01 Impact Factor