June 14, 1999
Psychiatric medications have come a long way. New research presented at May 1999 Annual Meeting of the American Psychiatric Association provides psychiatrists and other physicians more flexibility in prescribing medications. A new selective serotonin re-uptake inhibitor (SSRI) Celexa was approved in 1998. Many studies this year focused on this new medication, which is being marketed as a less expensive and very selective SSRI (one which only targets serotonin, not other neurotransmitters). Some highlights from the research presented at the meeting:
One study on the use of Celexa in bipolar disorder found that "the high selectivity of citalopram [Celexa] to the serotonin transporter is associated with significantly reduced frequency of treatment-emergent manic episodes". ( Barak, et. al., 1999)
Another study found that "mirtazapine [Remeron] and citalopram [Celexa] were equally effective in reducing symptoms of depression and anxiety, and well tolerated. However, mirtazapine was significantly more effective than citalopram after two weeks of treatment on MADRS, HAM-A, and CGI-Severity of Illness and Quality of Life scales. This finding, consistently present at all major efficacy variables, suggests potentially faster onset of action of mirtazapine." (Agren, et. al., 1999)
A study found that: "Depressed patients who are discontinuing fluoxetine treatment because of an insufficient therapeutic response can be safely switched on the following day and successfully treated with another SSRI, citalopram [Celexa]." (Thase, et. al., 1999)
Researchers found that "Citalopram-plus-clomipramine [Celexa-plus-Anafranil] may be effective in refractory OCD; increased clomipramine levels are not a likely explanation. The 50% response rate to citalopram in our six SRI-intolerant patients suggests citalopram is effective for OCD. Double-blind controlled trials are needed to test our results." (Koran, et. al., 1999)
Recent studies have found that patients often experience symptoms when taken off SSRIs. A study found that patients who were taken off citalporam (Celexa) and given 8 weeks of a placebo instead suffered the following symptoms (versus those who stayed on the medication): "emotional indifference (5.6% vs. 0.7%), anxiety (5.6% vs. 2.0% impaired concentration (4.2% vs. 0% migraine (4.2% vs. 0.7% tremor (4.2% vs. 0.7%), and paresthesia (4.2% vs. 1.3%)." The authors state that "these events could suggest an increase in anxiety accompanying drug withdrawal, but also could reflect re-emergence of depressive symptoms." (Markowitz & Lindsay, 1999)
These studies are similar to those which come out when any new drug comes on the market. Basic safety and efficacy studies were done prior to the medication being approved. Physicians use research such as this to make decisions concerning what to prescribe.
References:
- Barak, Yoram, Kimhi, Robert & Weisman, Ronit. Serotonin selectivity reduces mania induction. Paper presented at the Annual Meeting of the American Psychiatric Association, May 1999.
- Agren, Hans; Leinonen, Esa; Skarstein, Jon; Behke, Kerstin & Schutte, Albert-Jan. Efficacy and Tolerability of Mirtazapine Versus Citalopram in Major Depression: A Double-Blind, Randomized Study. Paper presented at the Annual Meeting of the American Psychiatric Association, May 1999.
- Thase, Michael; Lydiard, R. Bruce & Feighner, John P. Citalopram Treatment of Fluoxetine Nonresponders. Paper presented at the Annual Meeting of the American Psychiatric Association, May 1999.
- Koran, Lorrin M.; Pallanti, Stefano; Paiva, Rogerio & Quercioli, Leonardo. Citalopram Plus Clomipramine for Refractory OCD. Paper presented at the Annual Meeting of the American Psychiatric Association, May 1999.
- Markowitz, John S. & C. Devane, Lindsay. Effects of Abrupt Discontinuation of Citalopram. Paper presented at the Annual Meeting of the American Psychiatric Association, May 1999.
