To assess the effectiveness of citalopram for major depressive disorder (MDD) in adults, in a systematic review of all published, randomised, double-blind studies comparing it with a placebo.
Cochrane Central Register of Controlled Trials, Medline, PsychINFO and Embase.
Randomised, double-blind, placebo-controlled studies of citalopram in adults with MDD were included. Studies with medically ill or treatment resistant subjects were excluded, as were studies of relapse prevention. Remission of MDD was defined as a primary outcome, and response or change from baseline scores were defined as secondary.
Remission, response and symptom improvement scores on the Hamilton Depression Scale, Montgomery–Asberg Depression Rating Scale and Clinical Global Impressions-Severity scales were extracted. A random-effects meta-analysis was carried out on the response rates and symptom improvement scores. Included studies were examined for the presence of bias and small study effects.
Eight studies (n=2025) met the inclusion criteria. Two studies provided data on remission, but only one of these showed a significant difference between citalopram and placebo (RR=1.59, 95% CI 1.10 to 2.31). Meta-analysis of response rates in five studies (n=1010) revealed significant superiority of citalopram (RR=1.42, 95% CI 1.17 to 1.73). Meta-analysis of change from baseline scores in five studies (n=1541) gave a standardised mean difference (Hedges' g) of −0.27 (95% CI −0.38 to to −0.16), showing a reduction in MDD symptoms to be significant for citalopram relative to placebo. There was no evidence of any significant small study effects. The overall quality of reporting was poor, with insufficient information on the methodology or outcomes. Seven studies received industry sponsorship.
Data concerning remission rates for citalopram, relative to placebo, are inconclusive. Response rates and symptom reduction scores in citalopram-treated patients with MDD are significantly better relative to placebo treatment, according to a meta-analysis of published reports. Evaluation of unpublished data is necessary to assess more definitively the effectiveness of citalopram for MDD.
Systematic review and meta-analysis of published randomised double-blind studies comparing citalopram with placebo in adults with major depressive disorder (MDD).
Evaluation of the quality of published studies and the risk of bias.
Data on remission rates for citalopram in MDD, relative to placebo, are inconclusive
Response rates and symptom improvement scores are significantly better in citalopram-treated patients than in those taking placebo.
The quality of reporting in published studies is poor.
Further evaluation of citalopram is necessary, incorporating unpublished research.
Strengths and limitations of this study
This review is based on a thorough search for published placebo-controlled studies of citalopram for adults with MDD, using a broad search strategy. In a departure from previously published reviews, this study assesses the risk of bias and includes remission as a primary outcome.
This study would have been enhanced if the missing data were available for a more complete analysis, and unpublished studies satisfying inclusion criteria were incorporated into this review.
This review was carried out by a single author.