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Psychotropic Use during Pregnancy
Published in “Bert” Bertis Britt Little, Drugs and Pregnancy, 2022
Citalopram is an SSRI used to treat depression. Among 125 pregnancies with 114 live-born infants whose mothers took citalopram during the first trimester, there was one (0.9 percent) congenital anomaly (Sivojelezova et al., 2005). The authors concluded that the drug was not associated with congenital anomalies with exposure during early pregnancy, but that use of citalopram in late pregnancy was associated with increased frequency of poor neonatal adaptation, recently reported with other SSRIs (Chambers et al., 1996; Costei et al., 2002; Kallen, 2004; Nordeng et al., 2001; Oberlander et al., 2004). Analysis of the Swedish registry of 8015 pregnancies exposed to citalopram during the first trimester found no increased frequency of birth defects with first trimester exposure (Kallen, 2019). The frequency of diaphragmatic hernia was increased among 126 infants exposed to citalopram during organogenesis (Anderson et al., 2020).
Depression
Published in Henry J. Woodford, Essential Geriatrics, 2022
A trial of 4,041 younger adults with depression found a remission rate of approximately 30% after treatment with citalopram at a mean dose of 42 mg and a mean duration of 47 days (NB daily doses of citalopram in older people should not exceed 20 mg).28 Two further trials were performed with people from the initial cohort who failed to respond to, or were intolerant of, citalopram after up to 12 weeks of treatment. The first recruited 727 people (mean age 42) who agreed to participate in a randomised change in therapeutic agent to either bupropion-MR, venlafaxine-XR, or an alternative SSRI (sertraline).29 The study found that around 25% of patients had remission of their depressive symptoms irrespective of which agent was used. The second study enrolled people willing to add a second drug to citalopram.30 Here, 565 patients (mean age 41) were randomised to citalopram plus either bupropion-MR or buspirone (a serotonin receptor agonist). Similar remission rates of around 30% were seen in both groups. Withdrawal rates due to intolerance were lower with bupropion (13% v 21%). However, a placebo group was not used in either of the secondary studies and so true effect sizes cannot be calculated. Taken together these studies suggest that around 50% of younger adults with severe, recurrent depression will not achieve remission with pharmacotherapy.
Pharmacology
Published in Bhaskar Punukollu, Michael Phelan, Anish Unadkat, MRCPsych Part 1 In a Box, 2019
Bhaskar Punukollu, Michael Phelan, Anish Unadkat
Insomnia or excessive sleep: SSRIs usually lead to improved sleep but some SSRIs may cause insomnia or excess sleep in some individuals. Fluoxetine is most likely to cause insomnia although uncommon. Citalopram is most likely to cause excess sleepiness although uncommon.
Can pharmacotherapy effectively reduce Alzheimer’s related agitation?
Published in Expert Opinion on Pharmacotherapy, 2020
Madia Lozupone, Maddalena La Montagna, Rodolfo Sardone, Davide Seripa, Antonio Daniele, Francesco Panza
Citalopram has been prioritized over antipsychotics as first-line pharmacotherapy. A multicenter RCT (CitAD) showed the efficacy of citalopram for AD patients with agitation based on clinical global and agitation scale outcomes [6]. The effect size was clinically relevant: 40% of citalopram-treated participants were judged to be much improved on the modified Alzheimer Disease Cooperative Study-Clinical Global Impression of Change vs. 26% of those on placebo, although a modest cognitive decline was seen in the citalopram group over 9 weeks at Mini Mental State Examination (MMSE) scores and the known selective serotonin reuptake inhibitor-mediated side effects included a delayed cardiac repolarization (suggested by a prolongation of the ECG-QTc interval). In a subgroup analysis, among patients with agitation treated with citalopram (at 30 mg per day), those with the mild-moderate symptoms appeared to respond best if more mildly cognitively impaired (MMSE ≥21) and within the middle age range (76 to 82 years), while those with more severe agitation and who are under lorazepam prescription demonstrated less efficacy and more side effects [7].
Pharmacotherapeutic strategies for the treatment of anorexia nervosa – too much for one drug?
Published in Expert Opinion on Pharmacotherapy, 2020
The most frequently prescribed psychiatric medications, the so-called serotonin reuptake inhibitors (SSRIs) have FDA indications for depression, anxiety, and OCD and seemed an ideal medication class to use in anorexia nervosa to reduce eating disorder-related anxiety and support recovery. In addition, in about half of individuals on any SSRI the medication promotes some weight gain [22]. However, the results have been overall disappointing. After some promising reports using the SSRI fluoxetine, larger controlled studies did not reveal benefits for weight gain, or weight maintenance [23–25] or relapse prevention of anorexia nervosa. The overall largest study that was done by Walsh et al. followed in a double blind design individuals with anorexia nervosa over 52 weeks, with 49 participants on active drug fluoxetine and 44 on placebo [26]. Other studies tested citalopram, sertraline or paroxetine, with no clear benefits for weight gain, although there was some indication that those medications might have helped with body dissatisfaction and mood [27,28].
Review of the clinical approach to the treatment of disruptive mood dysregulation disorder
Published in International Review of Psychiatry, 2020
Brian Hendrickson, Mahlet Girma, Leslie Miller
Researchers conducted a study examining the effectiveness of citalopram in 53 youth (ages 7–17) with SMD and ADHD (Towbin et al., 2019). Of note, 98% of youth also met criteria for DMDD. After enrolment, youth underwent a 2-week medication wash out phase followed by 5 weeks of open treatment with MPH to achieve optimal control of ADHD symptoms. After MPH treatment, 11 (or 16%) youth no longer met study criteria due to low irritability. The remaining 53 (77%) participants who continued to meet criteria for SMD were randomized to an 8-week blinded study of citalopram versus placebo. Ultimately, 25 youth were randomized to citalopram and 28 to placebo. Citalopram dose started at 5 mg with dosage increases by 5 mg every 5–7 days until a maximum of 40 mg based on ongoing symptoms and tolerability of medication. At the week 8 end-point assessment, 35% of the citalopram group compared to 6% of the placebo group were considered treatment responders (defined as CGI-I of 2 ‘much improved’ or 1 ‘symptom free’; Towbin et al., 2019). There was however no significant difference in functional impairment as measured by the CGAS.