Major depressive disorder is one of the most common mood disorders among adults. Conventional wisdom holds that in uncomplicated cases, Celexa (citalopram) is a good first-choice treatment for adults exhibiting symptoms of depression. Multiple clinical trials have demonstrated that Celexa combines effectiveness with safety and tolerability. In contrast with older classes of antidepressant medications, such as the tricyclics, Celexa is unlikely to cause side effects serious enough to discourage a patient from continuing with treatment.
Clinical trials and studies of antidepressant medications may have a significant blind spot in their experimental design. In most trials, success is measured in terms of how much improvement is seen in symptoms of depression. However, from a patient’s point of view, remission (i.e., complete removal) might be the only outcome that truly matters. Symptomatic improvement, no matter how significant for researchers, may be meaningless for someone with severe depression. With this in mind, Apler (2011) undertook a retrospective analysis of Celexa studies to determine just how effective the medication really is when the desired outcome is remission rather than just symptomatic improvement. Apler also looked for potential limitations within various study designs.
As a first-line treatment for major depressive disorder, Celexa demonstrates statistically significant effectiveness across a variety of patient profiles. However, the long-term efficacy is unclear. What’s more unsettling is that relatively few data exist on remission rates. Apler found two studies that specifically looked to remission as an outcome. One study showed significant results versus placebo, and another did not. In other words, there is no significant evidence as of yet that Celexa alone can trigger remission of major depressive disorder.
Apler’s analyses of published data are not intended to discourage the use of Celexa. Rather, antidepressant medications should never be the lone treatment used for mood disorders. Cognitive behavioral therapy, among other forms of social support, is essential for adults with major depressive disorder. Many of the studies clearly showed that medication plus therapy leads to more positive outcomes than medication alone. Apler is correct to point out that more research is necessary in terms of defining remission as the most desirable outcome. This will require some uncompromising, challenging experimental designs, but the rewards will eventually be worth the effort.
Apler, A. (2011). Citalopram for major depressive disorder in adults: a systematic review and meta-analysis of published placebo-controlled trials. BMJ Open, 2: e000106. doi:10.1136/bmjopen-2011-000106
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