Efficacy measures were total score on the rating scales, their change from baseline, or the response rate. Responders were generally defined as patients with a decrease in the HAMD or MADRS total score of at least 50% after at least 3 weeks of therapy (or time not given), or a score of 1 or 2 on the CGI. Parallel-group dose comparison studies Citalopram The short-term studies with citalopram did not show significant differences In terms of clinical efficacy across a dose range of 20 to 60 mg/day Even a dose of 10 mg/day was effective compared with placebo.10 The results of the maintenance

Inhibitors,research,lifescience,medical study by Montgomery et al11 and the meta-analysis by the same authors12 support these findings. Therefore, for the majority of patients, there Is no advantage of increasing the dose of citalopram above 20 mg/day. The study by Montgomery et al11 Is particularly Interesting, because, In the acute double-blind phase of one of the two Initial studies (Table I),13 citalopram 20 mg/day was no more effective Inhibitors,research,lifescience,medical than placebo. However, in the long-term phase, the relapse rate was similar In the group of responders Inhibitors,research,lifescience,medical on citalopram 20 mg/day who were randomized to placebo and In the group of those who were responders and continued In double-blind on placebo, but higher than in the group of those who were randomized to continue on citalopram

20 mg/day. These results Inhibitors,research,lifescience,medical tend to show that citalopram 20 mg/day was effective in the acute phase despite the observation that it was not significantly different from placebo. Table I Selective and serotonin reuptake inhibitors (SSRls) and dose-efficacy relationship in parallel-group dose comparison studies ranked in order of increased efficacy. HAMD, Hamilton Rating Scale for Depression; MADRS, Montgomery and Åsberg Depression … The study by Montgomery et al13 failed Inhibitors,research,lifescience,medical to show a benefit of citalopram 20 mg/day on the HAMD 17 Items and MADRS total scores In a group

of 56 évaluable patients, ie, those who remained at least 3 weeks In the study; only citalopram 40 mg/day, In a group of 49 évaluable patients, was superior to placebo and to citalopram 20 mg/day. When using change on the HAMD and MADRS total score, citalopram 20 and 40 mg/day were no different from placebo. Using the 50% reduction on the HAMD and MADRS total score, there were no differences between citalopram 20 and 40 mg/day and placebo at the end of 6 weeks. In other words, there DNA ligase were no more responders In the two citalopram CDK inhibitor groups than In the placebo group. All analyses were carried out on a LOCF. In a large study by Felghner and Overo (Table I), 14 citalopram 40 and 60 mg/day, but not 10 and 20 mg/day, were more effective than placebo on change on the HAMD 21 Items total score on ITT-LOCF at the end of 6 weeks. However, there was no statistical analysis comparing the different doses of citalopram.