Citalopram is less effective for patients with neurological disorder and/or post-traumatic stress disorder

Importance Citalopram is a common antidepressant widely used and STAR*D study has indicated that most, more than 60%, of patients who receive it, do not benefit from their first antidepressant. Objective To identify whether citalopram is effective for patients with particular medical history. Design We used stratification to balance case/control study design. Setting We used the National Institute of Mental Health's STAR*D data, collected from 41 specialty and primary medical care settings spanning across a seven year time period. Participants The data included .mental and physical diagnoses of 4041 patients with major depression. Intervention(s) (for clinical trials) or exposure(s) (for observational studies) Patients comorbidities were balanced using Stratified Covariate Balancing method. This algorithm uses Markov Blanket of both treatment and outcome to identify which comorbidities can be ignored. It uses stratification to remove confounding introduced by the covariates in the Markov Blanket of treatment and outcome. Main outcome(s) and measure(s) A patient's remission was judged by weather there was a 50% reduction in the Hamilton Rating Scale for Depression. Results Patients exposed to neurological disorders were less likely to experience remission than controls without neurological disorder (odds=0.74, chi-square=, alpha Conclusions and relevance Patients exposed to PTSD or neurological disorders were less likely to experience remission from depression. These data suggest that citalopram should not be a first line agent prescribed for patients with these disorders.