Usefulness of serotoninergic challenge with oral citalopram / Utilidade do desafio serotoninérgico com citalopram oral

OBJECTIVE: Challenge tests designed to evaluate serotoninergic pathways have widely used intravenous citalopram. Oral citalopram has also been used, but unsatisfactory results were obtained with a dose of 20 mg. The objective of this study was to determine whether a higher oral dose would reproduce similar to those described for intravenous administration. To that end, we evaluated cortisol, growth hormone and prolactin levels. METHOD: Eight healthy male volunteers were evaluated in a randomized crossover challenge test with 40 mg of oral citalopram or placebo. RESULTS: Cortisol levels increased at 2-4h after the oral citalopram intake, with a small amplitude peak occurring in two-thirds of the subjects. Levels of prolactin and growth hormone remained unchanged throughout the study. CONCLUSION: The use of oral citalopram might present an alternative in serotoninergic challenge tests, but higher doses are required.

OBJETIVO: Testes-desafio desenvolvidos para avaliar as vias serotoninérgicas utilizaram amplamente citalopram intravenoso. Citalopram oral também foi utilizado, mas obtiveram-se resultados insatisfatórios com uma dose de 20 mg. O objetivo deste estudo foi o de determinar se uma dose oral mais elevada poderia reproduzir resultados similares aos descritos para administração intravenosa. Com esta finalidade, avaliamos os níveis de cortisol, de hormônio do crescimento e de prolactina. MÉTODO: Oito voluntários do sexo masculino saudáveis foram avaliados em um teste-desafio cruzado, aleatorizado, com 40 mg de citalopram oral ou placebo. RESULTADOS: Os níveis de cortisol aumentaram após 2-4 horas da ingestão de citalopram oral, com um pequeno pico de amplitude ocorrendo em dois terços dos indivíduos. Os níveis de prolactina e de hormônio de crescimento permaneceram inalterados ao longo do estudo. CONCLUSÃO: O uso de citalopram oral poderia apresentar uma alternativa em testes-desafio serotoninérgicos, mas doses maiores são necessárias.

Citalopram in depressive disorders

Citalopram is a bicyclic phthaline and one of the newer Serotonin Specific Reuptake Inhibitors [SSRI] now available in Pakistan. A four weeks, open, clinical trial was carried out on 36 moderate to severely depressed patients to determine the efficacy and tolerability of this newer antidepressant. Twenty six% of patents showed improvement on Hamilton Rating Scale for Depression [HAMD] in the first week and fifty eight% at the end of four weeks [P<0 001] On CGI twenty eight% improved at the end of the study [P<0.001]. Sixty eight% of patients having suicide tendencies showed significant improvement. No significant changes in the ECG were recorded. No significant decrease in heart rate or drop in blood pressure was noted.The side effects were very few as the drug did not cause distressing anticholinergic effects or weight gain. This study supports the efficacy of citalopram for treatment of patients with moderate to severe depression However higher cost of the drug may restrict Its use for some of our patients