Citalopram indications

Differentiating between depression and dementia can be difficult, so symptoms of depression should be documented for several weeks prior to initiating therapy for the treatment of depression with AD. Citalopram and sertraline are recommended as first-line agents because of their efficacy in placebo-controlled trials.49 Indications for the use of antidepressants include depression characterized by poor appetite, insomnia, hopelessness, anhedonia, withdrawal, suicidal thoughts, and agitation. 

Another potential indication for SSRIs is irritable bowel syndrome (IBS). Citalopram has recently been reported to significantly improve abdominal pain, bloating, impact of symptoms on daily life, and overall well being compared... 

In the antipressant group, 92.1% were treated with a SSRI, most commonly citalopram (47.9%) or sertraline (29.3%). The indications for prescribing antidepressants were depression in 59.2%, OCD in 29.8%, anxiety disorder in 10.7%, and eating disorder in 6.3% of those treated with an antidepressant (Sorensen et al. 2002, in press). Of the total population of 0 to 8-year-... 

Treatment of psychiatric complications should generally be along standard lines for the respective conditions. Some syndromes appear to be brief and self-limiting once ecstasy use stops, but a more chronic course may also be seen, with cases in the literature of psychoses which prove resistant to treatment (Vecellio et al. 2003). Whichever psychiatric syndrome occurs, there is possibly a theoretical indication for specific serotonergic re-uptake inhibitors such as fluoxetine, sertraline or citalopram, given the effect of ecstasy in reducing serotonin transmission. This would purely be a pragmatic approach which has not yet been properly tested, and it may be that the transmission abnormalities are not amenable to this kind of enhancement. 

Zimelidine was the first serotonin reuptake inhibitor available for clinical use, but in 1982 was withdrawn worldwide because of its toxicity ( 110). Despite this initial setback, five members of this class have been marketed in the United States and various countries around the world citalopram (Celexa), fluoxetine (Prozac), fluvoxamine (Luvox), paroxetine (Paxil), and sertraline (Zoloft). All except fluvoxamine have marketed indications in the United States for the treatment of major depression. Fluvoxamine is marketed in the United States for the treatment of obsessive-compulsive disorder rather than major depression, although it is marketed in a number of other countries for major depression. 

The selective serotonin reuptake inhibitors (SSRIs) represent a chemically diverse class of agents that have as their primary action the inhibition of the serotonin transporter (SERT) (Figure 30-3). Fluoxetine was introduced in the United States in 1988 and quickly became one of the most commonly prescribed medications in medical practice. The development of fluoxetine emerged out of the search for chemicals that had high affinity for monoamine receptors but lacked the affinity for histamine, acetylcholine, and adrenoceptors that is seen with the tricyclic antidepressants (TCAs). There are currently six available SSRIs, and they are the most common antidepressants in clinical use. In addition to their use in major depression, SSRIs have indications in GAD, PTSD, OCD, panic disorder, PMDD, and bulimia. Fluoxetine, sertraline, and citalopram exist as isomers and are formulated in the racemic forms, whereas paroxetine and fluvoxamine are not optically active. Escitalopram is the S enantiomer of citalopram. As with all antidepressants,... 

The earliest and unfortunately still one of the commonest treatments of social phobia is self-medication with alcohol. The behaviorally disinhibiting actions of alcohol allow many social phobics to engage in social contacts that would otherwise be impossible. Legitimate therapeutic drugs for social phobia are now being discovered at a fast pace (Fig. 9—7). In fact, one of the SSRIs (paroxetine) already has been formally approved for use in the treatment of social phobia, and several other SSRIs and antidepressants are rapidly accumulating evidence of their efficacies in this condition as well. Specifically, studies of all five SSRIs (paroxetine, fluvoxamine, fluoxetine, sertraline, and citalopram) have indicated their efficacy in social phobia. Currently, SSRIs are considered first-line treatments for social phobia. 

Carbamazepine Some, but not all, reports indicate that carbamazepine serum levels can be increased by fluoxetine and fluvoxamine. Toxicity may develop. Sertraline normally appears not to affect carbamazepine, but sertraline levels may be reduced by carbamazepine. Isolated cases of Par-kinson-like and serotonin syndrome have occurred with fluoxetine and carbamazepine, while an isolated case of pancytopenia has been reported with sertraline and carbamazepine. The metabolism of citalopram may be increased. 

A number of studies have indicated the greater potency of (eudismic ratio between 130 and 160 [84,85]. As with fluoxetine, demethylation yields an active metaboHte, desmethylcitalopram, which in the case of the -enantiomer is approximately 6.7-fold less potent than the drug, but the eudismic ratio (S/R) decreases to 6.5. In this instance, the 7 -enantiomer of the metabolite is approximately fourfold more potent than (7 )-citalopram [84]. Following administration of the racemate to patients, the plasma concentrations of the 5-enantiomer are approximately one-third of those of the total drug, with a mean S/R ratio of 0.56 [86]. The single 5-enantiomer, given the generic name escitalopram, has been marketed since 2002. 

Other SSRIs were also at no increased risk of recurrence. Patients with breast cancer with indications for an SSRI may therefore in the authors view be given citalopram, and possibly other SSRIs, without adversely affecting the outcome of adjuvant therapy with tamoxifen. 

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