Citalopram versus desipramine in treatment resistant depression: Effect of continuation or switching strategies. A randomized open study

Abstract

Objectives. Evidence in favour of switching between selective serotonin reuptake inhibitor (SSRI) and tricyclic (TCA) antidepressants in treatment resistant depression has been tested in a few studies only, consequently a prospective study was undertaken to evaluate the impact of switching strategies. Methods. One hundred eighty-nine patients who failed to respond to a previous antidepressant were randomised to four arms: firstly they received citalopram or desipramine for a 4-week period; secondly, those who failed to respond were treated for a further 4-week period with the same antidepressant (citalopram-citalopram and desipramine-desipramine arms) or switched to the alternate one (citalopram-desipramine and desipramine-citalopram arms). Results. There was no difference in the first 4-week phase between patients receiving citalopram versus desipramine in Hamilton Rating Scale for Depression (HRSD), Montgomery–Asberg Depression Rating Scale (MADRS), and Clinical Global Impression (CGI) scores. In the second 4-week phase remitter rates were higher among non-switched patients (P = 0.04). Moreover, considering HRSD and MADRS, switched patients reported significantly higher scores (P ≤ 0.02 for both scales at each time-point). Conclusions. This study supports the thesis that switching from an SSRI to a TCA (and vice versa) in non-responders to a 4-week trial of an SSRI/TCA is not associated with improved response. The result goes in the opposite direction to that predicted by current guidelines.

Key words::

• Major depressive disorder
• antidepressants
• pharmacotherapy
• resistant depression
• switch

Acknowledgements

The study was sponsored by Lundbeck A/S and the Belgian National Fund for Scientific Research (FNRS; 3.4.530.07 F) by means of an unrestricted grant for the Group for the Study of Resistant Depression (GSRD). The sponsors had no role in the study design, analysis and writing of the paper. All authors were actively involved in the analytical method of the study, selection and review of all scientific content and had full editorial control during writing of the manuscript.

Statement of Interest

Dr Serretti is or has been consultant/speaker for: Astra Zeneca, Boheringer, BMS, Eli Lilly, GlaxoSmithKline, Janssen, Lundbeck, Pfizer, Sanofi, Servier. Dr Kasper has received grant/research support from Eli Lilly, Lundbeck, Bristol-Myers Squibb, GlaxoSmithKline, Organon, Sepracor and Servier; has served as a consultant or on advisory boards for AstraZeneca, Bristol-Myers Squibb, GlaxoSmithKline, Eli Lilly, Lundbeck, Pfizer, Organon, Schwabe, Sepracor, Servier, Janssen, and Novartis; and has served on speakers’ bureaus for AstraZeneca, Eli Lily, Lundbeck, Schwabe, Sepracor, Servier, Pierre Fabre, and Janssen. Professor Montgomery is or has been consultant/speaker for: AstraZeneca, Bristol Myers Squibb, Eli Lilly, GlaxoSmithKline, Johnson & Johnson, Lundbeck, Merck, Merz, Neurim, Pierre Fabre, Pfizer, Sanofi, Servier, Shire, Sepracor, Takeda, Targacept, Wyeth, Bionevia, M's Science, Otsuka, Pharmaneuroboost, Richter, Roche, Theracos, Transcept, UBC and Xytis. Dr Konstantinidis has received honoraria from Pfizer and AstraZeneca, served as consultant for AstraZeneca, and as a speaker for AstraZeneca and Bristol Myers Squib. Professor Mendlewicz, Drs Bollen, Demyttenaere, Linotte, Massat, Oswald, Zohar, Calati and Souery report no financial or other relationship relevant to the subject of this article.