Related Experiment Video
Updated: Oct 2, 2025
05:42
The Forced Swim Test as a Model of Depressive-like Behavior
Published on: March 2, 2015
38.0K
Dear Doctor Letters regarding citalopram and escitalopram: guidelines vs real-world data
Mateo de Bardeci1,2, Waldemar Greil3,4, Hans Stassen2,5
1Department of Psychiatry and Psychotherapy, Ludwig Maximilian University, Nussbaumstr. 7, 80331, Munich, Germany.
European Archives of Psychiatry and Clinical Neuroscience
|February 26, 2022
Summary
Dear Doctor Letters (DDLs) on citalopram and escitalopram QTc-prolonging effects improved adherence in younger patients but showed limited impact on elderly and combination therapies. Prescription patterns shifted, with citalopram decreasing and sertraline increasing.
Area of Science:
- Pharmacovigilance
- Clinical Pharmacy
- Psychiatry
Background:
- Dear Doctor Letters (DDLs) issued in 2011 warned about QTc-prolonging effects and torsade de pointes risk with citalopram and escitalopram.
- Major depressive disorder (MDD) patients are often treated with these selective serotonin reuptake inhibitors (SSRIs).
Purpose of the Study:
- To evaluate the impact of 2011 DDLs on the prescription behavior of citalopram and escitalopram.
- To assess adherence to new maximum dosage limits and avoidance of contraindicated drug combinations.
Main Methods:
- Analysis of pharmacovigilance data (Arzneimittelsicherheit in der Psychiatrie, AMSP) from 2001-2017, including 8,842 inpatients treated with citalopram/escitalopram for MDD.
- Comparison of psychotropic drug prescriptions before and after DDL issuance in 43,480 MDD inpatients.
- Examination of dosage adherence and avoidance of QTc-prolonging drug combinations.
Main Results:
- Proportion of patients exceeding new citalopram/escitalopram limits decreased, particularly in younger patients (≤65 years).
- Adherence to avoiding QTc-prolonging psychotropic drug combinations improved insignificantly (35.9% to 30.9%).
- Significant reduction in high-dose quetiapine (>150 mg/day) when co-prescribed with citalopram/escitalopram (53% to 35%).
- Post-DDL, citalopram prescriptions decreased, while sertraline prescriptions increased.
Conclusions:
- DDLs influenced prescription patterns but adherence was suboptimal, especially in elderly patients and for combination therapies.
- Therapeutic needs of specific patient populations may influence adherence to DDL recommendations.
- Official drug safety warnings should consider clinical requirements for effective implementation.
Related Concept Videos
01:25Antidepressant Drugs: Overview
853
Antidepressant drugs are a class of medications primarily used for treating various mood disorders, including major depression, anxiety disorders, and other related conditions. These medicines work by modulating the neurotransmitter balance within the brain, alleviating depressive symptoms. Antidepressants can be broadly categorized into several groups according to their mechanism of action and chemical structure: Selective Serotonin Reuptake Inhibitors (SSRIs), Serotonin-Norepinephrine...
853
01:28Antidepressant Drugs: Tricyclics, SSRIs, and SNRIs
700
Tricyclic Antidepressants (TCAs), including Desipramine (Norpramin), Imipramine (Tofranil), Clomipramine (Anafranil), and Amitriptyline (Elavil), inhibit serotonin and norepinephrine reuptake and also block other receptors. They are used for depression, pain conditions, and insomnia. Common adverse effects include anticholinergic effects, sedation, orthostatic hypotension, and weight gain. They have a narrow therapeutic window and so require plasma-level monitoring. Abrupt discontinuation can...
700
01:23Antidepressant Drugs: MAOIs and Other Agents
401
Atypical antidepressants, including bupropion (Wellbutrin), mirtazapine (Remeron), nefazodone (Serzone), trazodone (Desyrel), and vilazodone (Viibryd), offer unique mechanisms of action. Bupropion weakly inhibits dopamine and norepinephrine reuptake, aiding depression treatment and smoking cessation, with a low risk of sexual dysfunction. Mirtazapine enhances serotonin and norepinephrine neurotransmission, leading to sedation, increased appetite, and weight gain. As a result, it helps treat...
401
01:28Drug Therapy
111
The advent of drug therapy has profoundly shaped modern mental health care, providing targeted treatments for a range of psychological disorders. Psychotherapeutic drugs, classified into antianxiety, antidepressant, and antipsychotic medications, address symptoms across anxiety disorders, mood disorders, and schizophrenia. While these medications have transformed patient outcomes, they require careful management due to their potential side effects and limitations.
Antianxiety Medications
Antianxiety Medications
111
01:23Nonlinear Pharmacokinetics: Dependence of Elimination Half-Life and Dose Clearance
331
The elimination half-life and drug clearance of drugs following nonlinear kinetics can vary with dosage. The Michaelis-Menten parameters and drug concentration influence these factors. As the dose increases, the elimination half-life tends to lengthen, resulting in a reduction in clearance and a disproportionately larger area under the curve. The total clearance can be derived from the Michaelis-Menten equation for drugs following a one-compartment model.
A study on guinea pigs examined the...
A study on guinea pigs examined the...
331
01:30Electroconvulsive Therapy
242
Electroconvulsive therapy (ECT), or shock therapy, remains a critical biomedical intervention for severe, treatment-resistant depression. While its origins can be traced back to Hippocrates' observations that malaria-induced convulsions alleviated mental illness, modern ECT has evolved significantly from its earlier, more primitive applications. First introduced in 1938 by Ugo Cerletti and his colleagues, ECT involves inducing controlled seizures using electrical currents. In its early...
242