Efficacy of an Eight Week Trial of Imipramine and Citalopram in Patients with Mixed Anxiety-Depressive Disorder
Abstract
Objective: Mixed anxiety-depressive disorder (MADD) is a condition in which patients have both anxiety and depressive symptoms but do not meet the diagnostic criteria for either an anxiety disorder or a mood disorder. The aim of this study was to compare the efficacy of imipramine and citalopram in the treatment of MADD.
Methods: Fifty one outpatients aged 18 to 55 who were diagnosed with MADD were randomly assigned to receive citalopram or imipramine for 8 weeks. Patients were assessed using Hamilton Depression Rating Scale (HDRS) and Hamilton Anxiety Rating Scale (HARS) at baseline, weeks 4 and 8 of the study. The mean differences in Hamilton scores from the baseline were used as the main outcome measures of response to treatment.
Results: Thirty six patients completed the study. Patients in the citalopramgroup (n=20) received a mean dosage of 22 mg per day during the first 4 weeks and a mean dosage of 33 mg per day during weeks 4 to 8. Subjects in the Imipramine group (n= 16) received a mean dosage of 77 mg per day during the first 4 weeks and a mean dosage of 89 mg per day during weeks 4 to 8. It was noted that the both treatments were effective on depression andanxiety at the end of the fourth and eighth weeks. However, the mean differences of HDRS and HARS scores between citalopram and imipraminegroups were not significantly different at the end of weeks 4 and 8.
Conclusion: The results of this study suggest that the efficacy of regular doses of citalopram is comparable with lower range of therapeutic doses of imipramine in the treatment of MADD. A more comprehensive study is warranted to confirm the results of this study.
American Psychiatric Association. Diagnostic and Statistical Manual of Mental Disorders: DSM-IVTM. 4th ed. Washington, DC: American Psychiatric Association; 1994.
Stein MB, Kirk P, Prabhu V, Grott M, Terepa M. Mixed anxiety-depression in a primary-care clinic. J Affect Disord 1995; 34: 79-84.
Gorman JM. Comorbid depression and anxiety spectrum disorders. Depress Anxiety 1996; 4: 160-168.
Zimmerman M, Chelminski I, McDermut W. Major depressive disorder and axis I diagnostic comorbidity. J Clin Psychiatry 2002; 63: 187-193.
Silverstone PH, von Studnitz E. Defining anxious depression: going beyond comorbidity. Can J Psychiatry 2003; 48: 675- 680.
Brunello N, Blier P, Judd LL, Mendlewicz J, Nelson CJ, Souery D, et al. Noradrenaline in mood and anxiety disorders: basic and clinical studies. Int Clin Psychopharmacol 2003; 18: 191-202.
Carrasco JL, Diaz-Marsa M, Saiz-Ruiz J. Sertraline in the treatment of mixed anxiety and depression disorder. J Affect Disord 2000; 59: 67-69.
Cryan JF, Kaupmann K. Don't worry 'B' happy!: a role for GABA(B) receptors in anxiety and depression. Trends Pharmacol Sci 2005; 26: 36-43.
Mendlewich J. Optimizing antidepressant use in clinical practice: towards criteria for antidepressant selection. Br J Psychiatry 2001; 179(Suppl): 1–3.
Faravelli C, Cosci F, Ciampelli M, Scarpato MA, Spiti R, Ricca V. A self-controlled, naturalistic study of selective serotonin reuptake inhibitors versus tricyclic antidepressants. Psychother Psychosom 2003; 72: 95-101.
Hirschfeld RM. Efficacy of SSRIs and newer antidepressants in severe depression: comparison with TCAs. J Clin Psychiatry 1999; 60: 326-335.
Cipriani A, Brambilla P, Furukawa T, Geddes J, Gregis M, Hotopf M, et al. Fluoxetine versus other types of pharmacotherapy for depression. Cochrane Database Syst Rev 2005: CD004185.
Devane LC. Cyclic antidepressants. In: Murphy EJ, eds. Clinical Pharmacokinetics Pocket Handbook. Bethesda, MD: American Society of Health-System Pharmacy (ASHP); 1993. p. 49-70.
Reisby N, Gram LF, Bech P, Nagy A, Petersen GO, Ortmann J, et al. Imipramine: clinical effects and pharmacokinetic variability. Psychopharmacology (Berl) 1977; 54: 263- 272.
Milne RJ, Goa KL. Citalopram. A review of its pharmacodynamic and pharmacokinetic properties, and therapeutic potential in depressive illness. Drugs 1991; 41: 450-477.
Sajatovic M, Ramirez LF, eds. Rating scales in mental health (3nd ed). Hodson: Lexi-comp; 2001.
Ravindran AV, Judge R, Hunter BN, Bray J, Morton NH. A double-blind, multicenter study in primary care comparing paroxetine and clomipramine in patients with depression and associated anxiety. Paroxetine Study Group. J Clin Psychiatry 1997; 58: 112-118.
Marchesi C, Ceccherininelli A, Rossi A, Maggini C. Is anxious-agitated major depression responsive to fluoxetine? A double- blind comparison with amitriptyline. Pharmacopsychiatry 1998; 31: 216-221.
Versiani M, Ontiveros A, Mazzotti G, Ospina J, Davila J, Mata S, et al. Fluoxetine versus amitriptyline in the treatment of major depression with associated anxiety (anxious depression): a double-blind comparison. Int Clin Psychopharmacol 1999; 14: 321-327.
Files | ||
Issue | Vol 3 No 4 (2008) | |
Section | Articles | |
Keywords | ||
Anxiety disorder Citalopram Depressive disoder Imipramine |
Rights and permissions | |
This work is licensed under a Creative Commons Attribution-NonCommercial 4.0 International License. |