Prescribing Advice for GPs

An NHS Prescribing Advisers' Blog

Citalopram meta-analysis

The Cochrane Library has published the results of a meta-analysis that aimed to the efficacy, acceptability and tolerability of citalopram in comparison with other antidepressants in the treatment of major depression.

The review identified 37 trials that compared citalopram with other antidepressants including tricyclics, SSRIs and other antidepressants such as mirtazapine and venlafaxine. 16 of the studies had fewer than 100 participants. The mean sample size for each treatment group was 107 (range 33-303).

Citalopram was more effective than paroxetine (OR 0.65, 95% Confidence Interval [CI] 0.44-0.96) and reboxetine (OR 0.63, 95% CI 0.43-0.91) but less effective than escitalopram (OR 1.47, 95% CI 1.08-2.02). Additionally, fewer patients reported side effects when compared to tricyclics (OR 0.54, 95% CI 0.38-0.78).

The authors conclude that there are "Some statistically significant differences between citalopram and other antidepressants" but caution that there is "potential for overestimation of treatment effect due to sponsorship bias and publication bias". They recommend that clinicians consider efficacy and side-effect profiles when discussing and selecting a treatment.

Action: The conclusions of this analysis are in keeping with the current NICE Guideline on Depression in Adults. Clinicians should focus on clinically significant factors and continue implementing the NICE recommendations.

Thanks to Jane Dickson for spotting this article

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