Citalopram and anxiety disorders

The selective serotonin reuptake inhibitors (SSRIs) are effective and safe in a range of different anxiety disorders. This review focuses on citalopram, the most selective of the available SSRIs, in anxiety disorders (generalized anxiety disorder, panic disorder, social phobia, obsessive-compulsive disorder, posttraumatic stress disorder) as well as in anxiety-related conditions (obsessive-compulsive spectrum disorders, alcohol abuse, agitation associated with schizophrenia). An expanding body of evidence indicates that citalopram is not only effective and safe in the treatment of depression, but also useful in the treatment of generalized anxiety symptoms in a number of different conditions and populations. The therapeutic efficacy of citalopram in treating panic disorder has been known for at least a decade: in recent, double-blind studies this has been confirmed, and it has been shown that a dose of 20-30 mg/day is optimal. Patients with obsessive-compulsive disorder (OCD) respond well to treatment with citalopram; the evidence from open-label, multicentre trials has recently found confirmation in a large, multicentre, placebo-controlled, double-blind trial, with the superiority of citalopram over placebo being highly statistically significant at doses between 20 and 60 mg/day. Some patients with psychiatric disorders possibly closely related to OCD (termed OCD-spectrum disorders, and including trichotillomania, pica and olfactory reference syndrome), also appear, on current evidence, amenable to citalopram treatment. Citalopram has recently been found to be useful in the management of social phobia, with significant clinical improvement being seen at a median dose of 40 mg/day. Similarly, although there are few published accounts of citalopram use in treating post-traumatic stress disorder, significant improvement has been seen with this treatment in clinical practice. Analysis of pooled data from double-blind, placebo-controlled studies, involving almost 2000 patients, shows that citalopram treatment leads to a significant improvement of concomitant anxiety in depressed patients. Citalopram has been shown to be particularly useful in treating anxiety disorders in elderly patients, where it is one of the most preferred drugs because of its favourable adverse event and interaction profile, and in children. These findings, together with other reports of the efficacy of citalopram in the treatment of miscellaneous anxiety-related conditions (alcohol abuse, agitation associated with schizophrenia), lead to the conclusion that citalopram holds great promise for the safe and effective treatment of anxiety and anxiety disorders.