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Background: In 2011, direct healthcare professional communication (DHPC) letters on citalopram and escitalopram were sent out to address the risk of QTc prolongation in the ECG. Healthcare professionals were informed about a reduction of the maximum recommended daily dose. Furthermore, a contraindication for QTc-prolonging co-medication was given. Previous studies noted that these instructions were implemented incompletely., Aim: For the first time, this study analyzed how the DHPC affected the prescription of citalopram and escitalopram in patients with anxiety disorders., Methods: Drug utilization data from the project "Arzneimittelsicherheit in der Psychiatrie e. V." (AMSP) was used to examine whether the proportion of patients treated with a higher-than-recommended daily dose ("high dose") and the proportion of patients with QTc-prolonging co-medication would decrease post-DHPC (combined category of citalopram/escitalopram)., Results: Drug utilization data of n = 364 patients pre- and n = 262 patients post-DHPC were compared. The proportion of patients with high dose declined from 10.7% to 5.4% (p = 0.019). The proportion of patients with QTc-prolonging co-medication did not change significantly from pre- (54.7%) to post-DHPC (51.5%, p = 0.437)., Discussion: In accordance with previous studies, the proportion of high-dose patients decreased after DHPC publication while the proportion of patients with QTc-prolonging co-medication remained widely unchanged. The specific recommendation on daily dosage seems to have been better implemented than the broadly formulated contraindication of QTc-prolonging co-medication. Hence, DHPCs should be written precisely and give advice for specific clinical situations., (© 2022. Springer-Verlag GmbH Deutschland, ein Teil von Springer Nature.)

The review summarises the evidence supporting the choice of an antidepressant in primary care. We report current guidance on the choice of antidepressants and the current use of antidepressants in Germany. Evidence for the comparative efficacy of modern antidepressants, such as venlafaxine, duloxetine or agomelatine will be summarized with respect to depressive and accompanying symptoms. Furthermore, differences in adverse events between antidepressants will be reviewed., (© Georg Thieme Verlag KG Stuttgart · New York.)

Studies of the 1970s and 1980s showed lithium monotherapy to be an effective treatment of acute unipolar major depressive disorder (MDD) and hence as a potential alternative to monoaminergic antidepressants.The objective was to conduct the first comparison of a lithium monotherapy with a modern antidepressant in the acute treatment of MDD. Results were compared with citalopram's efficacy as shown in a different but methodologically identical study (including same researchers, same time, and same place).Thirty patients with an acute MDD (Structured Clinical Interview for the Diagnostic and Statistical Manual of Mental Disorders, Fourth Edition [DSM IV] I) were treated with lithium monotherapy (study 1) or with citalopram monotherapy (study 2, N = 32) for 4 weeks.Response rates (decrease in Hamilton Depression Rating Scale score >50%) were 50% for lithium and 72% for citalopram (P = 0.12). Citalopram-treated subjects showed a greater decrease in Hamilton Depression Rating Scale scores (significant at 2 weeks). In the lithium study, only patients with a recurrent episode (DSM-IV: 296.3) responded (15/22), as opposed to none of 8 patients with a first/single episode (DSM-IV: 296.2) (P = 0.002). Patients with a single episode responded significantly more often to citalopram than to lithium (P = 0.007). Both drugs were well tolerated. Only one patient (citalopram) terminated the study prematurely owing to adverse effects.Our results do not support the use of lithium as an alternative to SSRI in the treatment of acute MDD. The finding of a better response to lithium in patients with a recurrent depression has not been reported before and warrants replication. The comparison is limited by the lack of a randomized double-blind design.

Introduction: In this 16-week post-marketing surveillance (PMS) study, antidepressant effects and tolerability of escitalopram was examined in 2 911 patients with comorbid depression and anxiety., Methods: Antidepressant effects were assessed using a modified version of the Montgomery-Åsberg depression rating scale (svMADRS), the Hamilton anxiety scale (HAMA) and the hospital anxiety depression scale (HADS-D) and the clinical global impression scale (CGI-S, CGI-I)., Results: Treatment was completed by 2 718 patients, whose severity of depression decreased from a mean svMADRS total score of 33.0 to 8.9. At the end of the study, the remission rate (svMADRS≤12) was 72.9% and the response rate (≥50% decrease in svMADRS score) was 83.1% (LOCF). Similarly, the severity of anxiety symptoms decreased from a mean HAMA total score of 28.8-8.8; the remission rate (HAMA<10) was 63.9% and the response rate (decrease≥50%) was 80.2%. The most frequent adverse events were nausea (1.6%), agitation (1.1%) and fatigue (0.7%)., Discussion: Antidepressant effects and good tolerability of escitalopram were confirmed in everyday practice in patients with comorbid depression and anxiety. The high response and remission rates were within the range reported in previous RTC's of escitalopram vs. comparators or vs. placebo., (© Georg Thieme Verlag KG Stuttgart · New York.)

Objective: This report describes a case of subacute cutaneous lupus erythematosus (SCLE) in a patient treated with citalopram and discusses evidence linking selective serotonin reuptake inhibitors (SSRIs) to the induction of photosensitivity., Method: Case report and review of published literature., Results: A 71-year-old woman with major depression developed 2 days after intake of 20 mg citalopram a strongly itching and largely dimensioned confluencing erythema with infiltrations and blisters all over the trunk with fever and malaise. Histological and laboratory investigations were consistent with the diagnosis of SCLE. After stopping citalopram intake, dermatologic symptoms significantly improved within 2 weeks. SSRIs have been associated with 14 cases of adverse cutaneous events as a result of SSRI-induced photosensitivity. No case of SSRI-induced SCLE has been described., Conclusion: In clinical practice, indication and dosage of citalopram and other SSRIs should be carefully monitored. In the case of a SSRI-induced photosensitivity, medication can be switched to an antidepressant from another class., (Copyright © 2012 Elsevier Inc. All rights reserved.)

Background: An open, multi-centre study was designed to address the effectiveness and tolerability profile of treatment with escitalopram under naturalistic conditions, in elderly outpatients (above 65 years of age) with depression., Patients and Methods: A total of 2 050 patients completed 8 weeks of treatment with escitalopram. Rating scales included a short version of the Montgomery-Asberg Depression Rating Scale (svMADRS), the Clinical Global Impression - Severity scale (CGI-S), and the Clinical Global Impression -Improvement scale (CGI-I) for the assessment of various clinical parameters., Results: Most patients improved in their general state of health and showed a decrease in the severity of their depression. The majority (82.7%) of patients received initially 10 mg/day escitalopram. The mean svMADRS total score decreased from 31.9+/-7.9 at baseline to 14.2+/-8.5 at week 8. On completion, 63.9% of the patients were responders (> or =50% decrease of svMADRS total score from baseline) and 48.6% were remitters (svMADRS total score < or =12 at week 8). Statistically significantly more patients aged between 66 and 75 years responded to treatment and achieved remission than those aged >75 years. Logistic regression, using stepwise backward elimination, was used to model response to treatment. Statistically significant positive factors were having a current episode < or =1 month and duration of illness < or =1 year. Significant negative factors were being male, being older than 75 years, and having need of further psychotropic medication. Compared to patients diagnosed with unspecified dementia with other symptoms being predominantly depressive (F03, according to ICD-10), the response to escitalopram was significantly better for patients with depressive episodes (F32) or recurrent depressive episodes (F33), but significantly worse for patients with affective disorder (F31 or F34). The differences versus affective disorders were significant, while those for depressive episodes and recurrent depressive episodes vs. affective disorders were not significant., Conclusion: This observational study corroborates the effectiveness and tolerability of escitalopram treatment for elderly patients in a naturalistic treatment setting., (Copyright Georg Thieme Verlag KG Stuttgart · New York.)

Introduction: An open, multi-center, study was designed to address the efficacy and tolerability profile of treatment with escitalopram under naturalistic conditions in outpatients with depression., Methods: A total of 11,760 patients were treated with escitalopram and followed for 8 weeks. Rating scales included the Clinical Global Impression-Severity (CGI-S), the Clinical Global Impression-Improvement (CGI-I), and a short version of the Montgomery-Asberg Depression Rating Scale (svMADRS) for assessment of various clinical parameters., Results: During the course of the study, patients showed a clear pattern of improvement in their general state of health (CGI-S) and a decrease in the severity of their depression. The majority (82.8%) of patients initially received 10 mg/day escitalopram. By the end of the trial period, 32.5% of the patients were treated with 20 mg/day escitalopram compared to 64.0% receiving 10 mg/day escitalopram. After 2 weeks, 40.7% of patients were much or very much improved (CGI-I < or =2), increasing to 82.5% at the last assessment. There were no significant differences in response to treatment between women and men, with regard to treatment by specialists versus GPs, or with regard to age (< or =65 versus >65 years of age). Adverse reactions were similar to those found in controlled trials, and no new reactions were noted. The most common adverse reactions were nausea, anxiety, and vertigo., Conclusions: This observational study corroborates the high therapeutic efficacy of escitalopram treatment, while confirming the tolerability profile, in a naturalistic treatment setting.