The selective serotonin reuptake inhibitor citalopram was compared with clomipramine in a multicenter clinical study. From a total of 150 depressed patients (age 18–65 years), 114 patients with a Hamilton Depression Scale (HDS) total score≧18 at the end of a 1 week placebo period were started on treatment with either citalopram (40 mg/day) or clomipramine (150 mg/day) (fixed, single daily dose). Patients stratified according to diagnostic rating (Newcastle Inventory, endogenous/non-endogenous) were randomly allocated to treatment groups using double blind principles. In total, 102 patients completed more than 2 weeks, treatment and were included in the analyses of therapeutic effect. The two drug groups were comparable in terms of sex, age, and departmental distribution.

Categorical measurements of therapeutic effect based on the HDS total score showed that in the endogenously depressed patients a significantly higher percentage of patients on clomipramine (n=37) than on citalopram (n=38) were classified as complete responders (HDS total≦7) after 3, 4 and 5 weeks of treatment. In the non-endogenously depressed patients (clomipramine: n=15, citalopram: n=12) rather similar numerical differences were observed (P<0.05 at 5th week). In the total patient group the percentage of complete response after 5 weeks was about 60 in the clomipramine group (n=52) and about 30 in the citalopram group (n=50) (P<0.005). The better effect of clomipramine seemed to be related in particular to the sleep items, but other items covering depression, retardation and anxiety/agitation also contributed to the difference in total score that was also seen in patients with low initial scores on the sleep items.

Citalopram was devoid of the typical autonomic side effects and orthostatic hypotension seen with clomipramine. Symptoms of nausea/vomiting and headache became somewhat worse in the citalopram- and somewhat better in the clomipramine-treated patients.

Participating centers: 1Department of Psychiatry, Odense University Hospital, Odense, 2Department of Psychiatry, Rigshospitalet, University of Copenhagen, Copenhagen, 3Departments of Psychiatry, Frederiksborg General Hospital, Hillerød, 4Department A and C, Psychiatric University Hospital, Århus, 5Department of Psychiatry, Bornholm General Hospital, Rønne, 6Department of Clinical Pharmacology, Odense University, Odense

Participating clinicians: J. Andersen2, P. Bech2,3, S. Benjaminsen1, M. Bjerre1, S. Bøjholm5, P. Christensen1, A. Gjerris2, L. Hansted4, E. Jensen3, P. Kragh-Sørensen1, C.B. Kristensen1,3, P. Kyneb4, D. Loldrup3, O.F. Madsen4, O.L. Pedersen1, O.J. Rafaelsen2, S. Rasmussen3, N. Reisby4, F. Sevaj3, P. Simonsen4, H.Y. Thomsen1, P. Vestergaard4

Coordination and drug assay: L.F. Gram6

Statistical consultants: O. Aaskoven, P. Allerup

Data-collection and -processing: C. Sánchez

Steering Committee: P. Bech, L.F. Gram (chairman), P. Kragh-Sørensen, O.J. Rafaelsen, N. Reisby, P. Vestergaard