Citalopram w praktyce klinicznej Artykuł przeglądowy
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Opublikowane:
mar 31, 2025
Słowa kluczowe:
citalopram, SSRI, depresja, lęk
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Abstrakt
Citalopram jest lekiem z grupy inhibitorów wychwytu zwrotnego serotoniny o dobrze udokumentowanej skuteczności w terapii depresji, a także zaburzeń lękowych uogólnionych, lęku panicznego, zaburzenia obsesyjno-kompulsyjnego, zaburzeń przedmenstruacyjnych czy agitacji u chorych z otępieniem. Efekty terapii citalopramem weryfikowano także u osób ze schizofrenią lub z zaburzeniem związanym z używaniem alkoholu. Celem tej pracy jest podsumowanie obecnego stanu wiedzy na temat farmakokinetyki i farmakodynamiki, skuteczności oraz bezpieczeństwa citalopramu, a także zarysowanie jego roli w codziennej praktyce lekarza psychiatry.
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Jak cytować
Krupa, A. J., & Siwek, M. (2025). Citalopram w praktyce klinicznej . Medycyna Faktów , 18(1(66), 104-111. https://doi.org/10.24292/01.MF.0125.16
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Bibliografia
1. Cipriani A, Furukawa TA, Salanti G et al. Comparative efficacy and acceptability of 21 antidepressant drugs for the acute treatment of adults with major depressive disorder: a systematic review and network meta-analysis. Lancet. 2018; 391(10128): 1357-66. https://doi.org/10.1016/S0140-6736(17)32802-7.
2. Siwek M, Chrobak AA, Krupa AJ et al. TED (Trazodone Effectiveness in Depression): effectiveness of trazodone extended-release in subjects with unsatisfactory response to SSRIs. Psychiatr Pol. 2023: 1-18. https://doi.org/10.12740/PP/OnlineFirst/174432.
3. Dudek D, Chrobak AA, Krupa AJ et al. TED-trazodone effectiveness in depression: a naturalistic study of the effeciveness of trazodone in extended release formulation compared to SSRIs in patients with a major depressive disorder. Front Pharmacol. 2023; 14: 1296639. https://doi.org/10.3389/fphar.2023.1296639.
4. Kasper S, Sacher J, Klein N et al. Differences in the dynamics of serotonin reuptake transporter occupancy may explain superior clinical efficacy of escitalopram versus citalopram. Int Clin Psychopharmacol. 2009; 24(3): 119-25. https://doi.org/10.1097/YIC.0b013e32832a8ec8.
5. Siwek M. Dekalog leczenia depresji – kompendium. ITEM Publishing, Warszawa 2024.
6. Pollock BG. Citalopram: a comprehensive review. Expert Opin Pharmacother. 2001; 2(4): 681-98. https://doi.org/10.1517/14656566.2.4.681.
7. Pollock BG. Commentary on „When and How to Treat Agitation in Alzheimer’s Disease Dementia With Citalopram and Escitalopram”. Am J Geriatr Psychiatry. 2019; 27(10): 1108-9. https://doi.org/10.1016/j.jagp.2019.05.016.
8. Cytochrome P-450 CYP2C19 Inhibitors (strong).
9. Anderson LL, Doohan PT, Oldfield L et al. Citalopram and Cannabidiol: In Vitro and In Vivo Evidence of Pharmacokinetic Interactions Relevant to the Treatment of Anxiety Disorders in Young People. J Clin Psychopharmacol. 2021; 41(5): 525-33. https://doi.org/10.1097/JCP.0000000000001427.
10. Assimon MM, Pun PH, Al-Khatib SM et al. Proton pump inhibitors may enhance the risk of citalopram- and escitalopram-associated sudden cardiac death among patients receiving hemodialysis. Pharmacoepidemiol Drug Saf. 2022; 31(6): 670-9. https://doi.org/10.1002/pds.5428.
11. Montgomery S, Hansen T, Kasper S. Efficacy of escitalopram compared to citalopram: a meta-analysis. Int J Neuropsychopharmacol. 2011; 14(2): 261-8. https://doi.org/10.1017/S146114571000115X .
12. Fagan HA, Baldwin DS. Pharmacological Treatment of Generalised Anxiety Disorder: Current Practice and Future Directions. Expert Rev Neurother. 2023; 23(6): 535-48. https://doi.org/10.1080/14737175.2023.2211767.
13. Lenze EJ, Mulsant BH, Shear MK et al. Efficacy and tolerability of citalopram in the treatment of late-life anxiety disorders: results from an 8-week randomized, placebo-controlled trial. Am J Psychiatry. 2005; 162(1): 146-50. https://doi.org/10.1176/appi.ajp.162.1.146.
14. Montgomery S, Chatamra K, Pauer L et al. Efficacy and safety of pregabalin in elderly people with generalised anxiety disorder. Br J Psychiatry. 2008; 193(5): 389-94. https://doi.org/10.1192/bjp.bp.107.037788.
15. Mezhebovsky I, Mägi K, She F et al. Double-blind, randomized study of extended release quetiapine fumarate (quetiapine XR) monotherapy in older patients with generalized anxiety disorder. Int J Geriatr Psychiatry. 2013; 28(6): 615-25. https://doi.org/10.1002/gps.3867.
16. Guaiana G, Meader N, Barbui C et al. Pharmacological treatments in panic disorder in adults: a network meta-analysis. Cochrane Database Syst Rev. 2023; 11(11): CD012729. https://doi.org/10.1002/14651858.CD012729.pub3.
17. Uguz F. Citalopram in Treatment of Pregnant Women With Panic Disorder: A Retrospective Study. J Clin Psychopharmacol. 2020; 40(6): 615-7. https://doi.org/10.1097/JCP.0000000000001279.
18. Stein DJ, Andersen EW, Overo KF. Response of symptom dimensions in obsessive-compulsive disorder to treatment with citalopram or placebo. Braz J Psychiatry. 2007; 29(4): 303-7. https://doi.org/10.1590/s1516-44462007000400003.
19. Stein DJ, Montgomery SA et al. Predictors of response to pharmacotherapy with citalopram in obsessive-compulsive disorder. Int Clin Psychopharmacol. 2001; 16(6): 357-61. https://doi.org/10.1097/00004850-200111000-00007.
20. Marazziti D, Golia F, Consoli G et al. Effectiveness of long-term augmentation with citalopram to clomipramine in treatment-resistant OCD patients. CNS Spectr. 2008; 13(11): 971-6. https://doi.org/10.1017/s1092852900014024.
21. Jespersen C, Lauritsen MP, Frokjaer VG et al. Selective serotonin reuptake inhibitors for premenstrual syndrome and premenstrual dysphoric disorder. Cochrane Database Syst Rev. 2024; 8(8): CD001396. https://doi.org/10.1002/14651858.CD001396.pub4.
22. Wikander I, Sundblad C, Andersch B et al. Citalopram in premenstrual dysphoria: is intermittent treatment during luteal phases more effective than continuous medication throughout the menstrual cycle? J Clin Psychopharmacol. 1998; 18(5): 390-8. https://doi.org/10.1097/00004714-199810000-00007.
23. Parnowski T, Borzym A, Broczek K et al. Rekomendacje leczenia pobudzenia u chorych z otępieniem dla lekarzy POZ. Lekarz POZ. 2018; 4(4): 239-62.
24. Chen K, Li H, Yang L et al. Comparative efficacy and safety of antidepressant therapy for the agitation of dementia: A systematic review and network meta-analysis. Front Aging Neurosci. 2023; 15: 1103039. https://doi.org/10.3389/fnagi.2023.1103039.
25. Porsteinsson AP, Drye LT, Pollock BG et al.; CitAD Research Group. Effect of citalopram on agitation in Alzheimer disease: the CitAD randomized clinical trial. JAMA. 2014; 311(7): 682-91. https://doi.org/10.1001/jama.2014.93.
26. Viscogliosi G, Chiriac IM, Ettorre E. Efficacy and Safety of Citalopram Compared to Atypical Antipsychotics on Agitation in Nursing Home Residents With Alzheimer Dementia. J Am Med Dir Assoc. 2017; 18(9): 799-802. https://doi.org/10.1016/j.jamda.2017.06.010.
27. Aga VM. When and How to Treat Agitation in Alzheimer’s Disease Dementia With Citalopram and Escitalopram. Am J Geriatr Psychiatry. 2019; 27(10): 1099-107. https://doi.org/10.1016/j.jagp.2019.04.016.
28. Ehrhardt S, Porsteinsson AP, Munro CA et al.; S-CitAD Research Group. Escitalopram for agitation in Alzheimer’s disease (S-CitAD): Methods and design of an investigator-initiated, randomized, controlled, multicenter clinical trial. Alzheimers Dement. 2019; 15(11): 1427-36. https://doi.org/10.1016/j.jalz.2019.06.4946.
29. Hughes LE, Rittman T, Regenthal R et al. Improving response inhibition systems in frontotemporal dementia with citalopram. Brain. 2015; 138(Pt 7): 1961-75. https://doi.org/10.1093/brain/awv133.
30. Goff DC, Freudenreich O, Cather C et al. Citalopram in first episode schizophrenia: The DECIFER trial. Schizophr Res. 2019; 208: 331-7. https://doi.org/10.1016/j.schres.2019.01.028.
31. de Bardeci M, Greil W, Stassen H et al. Dear Doctor Letters regarding citalopram and escitalopram: guidelines vs real-world data. Eur Arch Psychiatry Clin Neurosci. 2023; 273(1): 65-74. https://doi.org/10.1007/s00406-022-01392-x.
32. Krupa AJ, Siwek M. Zaburzenia rytmu serca w przebiegu psychofarmakoterapii. In: Działania niepożądane i powikłania leczenia psychotropowego. Warszawa 2024: 315-28.
33. Aakjaer M, Werther SK, De Bruin ML et al. Serious arrhythmia in initiators of citalopram, escitalopram, and other selective serotonin reuptake inhibitors: A population-based cohort study in older adults. Clin Transl Sci. 2022; 15(9): 2105-15. https://doi.org/10.1111/cts.13319.
34. Hayes BD, Klein-Schwartz W, Clark RF et al. Comparison of toxicity of acute overdoses with citalopram and escitalopram. J Emerg Med. 2010; 39(1): 44-8. https://doi.org/10.1016/j.jemermed.2008.06.030.
35. Heinz MV, Yom-Tov E, Mackin DM et al. A large-scale observational comparison of antidepressants and their effects. J Psychiatr Res. 2024; 178: 219-24. https://doi.org/10.1016/j.jpsychires.2024.08.001.
2. Siwek M, Chrobak AA, Krupa AJ et al. TED (Trazodone Effectiveness in Depression): effectiveness of trazodone extended-release in subjects with unsatisfactory response to SSRIs. Psychiatr Pol. 2023: 1-18. https://doi.org/10.12740/PP/OnlineFirst/174432.
3. Dudek D, Chrobak AA, Krupa AJ et al. TED-trazodone effectiveness in depression: a naturalistic study of the effeciveness of trazodone in extended release formulation compared to SSRIs in patients with a major depressive disorder. Front Pharmacol. 2023; 14: 1296639. https://doi.org/10.3389/fphar.2023.1296639.
4. Kasper S, Sacher J, Klein N et al. Differences in the dynamics of serotonin reuptake transporter occupancy may explain superior clinical efficacy of escitalopram versus citalopram. Int Clin Psychopharmacol. 2009; 24(3): 119-25. https://doi.org/10.1097/YIC.0b013e32832a8ec8.
5. Siwek M. Dekalog leczenia depresji – kompendium. ITEM Publishing, Warszawa 2024.
6. Pollock BG. Citalopram: a comprehensive review. Expert Opin Pharmacother. 2001; 2(4): 681-98. https://doi.org/10.1517/14656566.2.4.681.
7. Pollock BG. Commentary on „When and How to Treat Agitation in Alzheimer’s Disease Dementia With Citalopram and Escitalopram”. Am J Geriatr Psychiatry. 2019; 27(10): 1108-9. https://doi.org/10.1016/j.jagp.2019.05.016.
8. Cytochrome P-450 CYP2C19 Inhibitors (strong).
9. Anderson LL, Doohan PT, Oldfield L et al. Citalopram and Cannabidiol: In Vitro and In Vivo Evidence of Pharmacokinetic Interactions Relevant to the Treatment of Anxiety Disorders in Young People. J Clin Psychopharmacol. 2021; 41(5): 525-33. https://doi.org/10.1097/JCP.0000000000001427.
10. Assimon MM, Pun PH, Al-Khatib SM et al. Proton pump inhibitors may enhance the risk of citalopram- and escitalopram-associated sudden cardiac death among patients receiving hemodialysis. Pharmacoepidemiol Drug Saf. 2022; 31(6): 670-9. https://doi.org/10.1002/pds.5428.
11. Montgomery S, Hansen T, Kasper S. Efficacy of escitalopram compared to citalopram: a meta-analysis. Int J Neuropsychopharmacol. 2011; 14(2): 261-8. https://doi.org/10.1017/S146114571000115X .
12. Fagan HA, Baldwin DS. Pharmacological Treatment of Generalised Anxiety Disorder: Current Practice and Future Directions. Expert Rev Neurother. 2023; 23(6): 535-48. https://doi.org/10.1080/14737175.2023.2211767.
13. Lenze EJ, Mulsant BH, Shear MK et al. Efficacy and tolerability of citalopram in the treatment of late-life anxiety disorders: results from an 8-week randomized, placebo-controlled trial. Am J Psychiatry. 2005; 162(1): 146-50. https://doi.org/10.1176/appi.ajp.162.1.146.
14. Montgomery S, Chatamra K, Pauer L et al. Efficacy and safety of pregabalin in elderly people with generalised anxiety disorder. Br J Psychiatry. 2008; 193(5): 389-94. https://doi.org/10.1192/bjp.bp.107.037788.
15. Mezhebovsky I, Mägi K, She F et al. Double-blind, randomized study of extended release quetiapine fumarate (quetiapine XR) monotherapy in older patients with generalized anxiety disorder. Int J Geriatr Psychiatry. 2013; 28(6): 615-25. https://doi.org/10.1002/gps.3867.
16. Guaiana G, Meader N, Barbui C et al. Pharmacological treatments in panic disorder in adults: a network meta-analysis. Cochrane Database Syst Rev. 2023; 11(11): CD012729. https://doi.org/10.1002/14651858.CD012729.pub3.
17. Uguz F. Citalopram in Treatment of Pregnant Women With Panic Disorder: A Retrospective Study. J Clin Psychopharmacol. 2020; 40(6): 615-7. https://doi.org/10.1097/JCP.0000000000001279.
18. Stein DJ, Andersen EW, Overo KF. Response of symptom dimensions in obsessive-compulsive disorder to treatment with citalopram or placebo. Braz J Psychiatry. 2007; 29(4): 303-7. https://doi.org/10.1590/s1516-44462007000400003.
19. Stein DJ, Montgomery SA et al. Predictors of response to pharmacotherapy with citalopram in obsessive-compulsive disorder. Int Clin Psychopharmacol. 2001; 16(6): 357-61. https://doi.org/10.1097/00004850-200111000-00007.
20. Marazziti D, Golia F, Consoli G et al. Effectiveness of long-term augmentation with citalopram to clomipramine in treatment-resistant OCD patients. CNS Spectr. 2008; 13(11): 971-6. https://doi.org/10.1017/s1092852900014024.
21. Jespersen C, Lauritsen MP, Frokjaer VG et al. Selective serotonin reuptake inhibitors for premenstrual syndrome and premenstrual dysphoric disorder. Cochrane Database Syst Rev. 2024; 8(8): CD001396. https://doi.org/10.1002/14651858.CD001396.pub4.
22. Wikander I, Sundblad C, Andersch B et al. Citalopram in premenstrual dysphoria: is intermittent treatment during luteal phases more effective than continuous medication throughout the menstrual cycle? J Clin Psychopharmacol. 1998; 18(5): 390-8. https://doi.org/10.1097/00004714-199810000-00007.
23. Parnowski T, Borzym A, Broczek K et al. Rekomendacje leczenia pobudzenia u chorych z otępieniem dla lekarzy POZ. Lekarz POZ. 2018; 4(4): 239-62.
24. Chen K, Li H, Yang L et al. Comparative efficacy and safety of antidepressant therapy for the agitation of dementia: A systematic review and network meta-analysis. Front Aging Neurosci. 2023; 15: 1103039. https://doi.org/10.3389/fnagi.2023.1103039.
25. Porsteinsson AP, Drye LT, Pollock BG et al.; CitAD Research Group. Effect of citalopram on agitation in Alzheimer disease: the CitAD randomized clinical trial. JAMA. 2014; 311(7): 682-91. https://doi.org/10.1001/jama.2014.93.
26. Viscogliosi G, Chiriac IM, Ettorre E. Efficacy and Safety of Citalopram Compared to Atypical Antipsychotics on Agitation in Nursing Home Residents With Alzheimer Dementia. J Am Med Dir Assoc. 2017; 18(9): 799-802. https://doi.org/10.1016/j.jamda.2017.06.010.
27. Aga VM. When and How to Treat Agitation in Alzheimer’s Disease Dementia With Citalopram and Escitalopram. Am J Geriatr Psychiatry. 2019; 27(10): 1099-107. https://doi.org/10.1016/j.jagp.2019.04.016.
28. Ehrhardt S, Porsteinsson AP, Munro CA et al.; S-CitAD Research Group. Escitalopram for agitation in Alzheimer’s disease (S-CitAD): Methods and design of an investigator-initiated, randomized, controlled, multicenter clinical trial. Alzheimers Dement. 2019; 15(11): 1427-36. https://doi.org/10.1016/j.jalz.2019.06.4946.
29. Hughes LE, Rittman T, Regenthal R et al. Improving response inhibition systems in frontotemporal dementia with citalopram. Brain. 2015; 138(Pt 7): 1961-75. https://doi.org/10.1093/brain/awv133.
30. Goff DC, Freudenreich O, Cather C et al. Citalopram in first episode schizophrenia: The DECIFER trial. Schizophr Res. 2019; 208: 331-7. https://doi.org/10.1016/j.schres.2019.01.028.
31. de Bardeci M, Greil W, Stassen H et al. Dear Doctor Letters regarding citalopram and escitalopram: guidelines vs real-world data. Eur Arch Psychiatry Clin Neurosci. 2023; 273(1): 65-74. https://doi.org/10.1007/s00406-022-01392-x.
32. Krupa AJ, Siwek M. Zaburzenia rytmu serca w przebiegu psychofarmakoterapii. In: Działania niepożądane i powikłania leczenia psychotropowego. Warszawa 2024: 315-28.
33. Aakjaer M, Werther SK, De Bruin ML et al. Serious arrhythmia in initiators of citalopram, escitalopram, and other selective serotonin reuptake inhibitors: A population-based cohort study in older adults. Clin Transl Sci. 2022; 15(9): 2105-15. https://doi.org/10.1111/cts.13319.
34. Hayes BD, Klein-Schwartz W, Clark RF et al. Comparison of toxicity of acute overdoses with citalopram and escitalopram. J Emerg Med. 2010; 39(1): 44-8. https://doi.org/10.1016/j.jemermed.2008.06.030.
35. Heinz MV, Yom-Tov E, Mackin DM et al. A large-scale observational comparison of antidepressants and their effects. J Psychiatr Res. 2024; 178: 219-24. https://doi.org/10.1016/j.jpsychires.2024.08.001.