Dysthymic disorder treatment is difficult to assess in clinical trials because of the variable course of depression severity in this condition. Most patients experience periods of major depression interspersed with periods of euthymia and milder depression.

Dr David Dunner and colleagues from the Center for Anxiety and Depression in Seattle set out to determine the dose range and safety of citalopram necessary for treatment and to achieve remission of dysthymic disorder.

They recruited 15 patients with this disorder to a 10-week, open-label pilot study with citalopram. The initial dose of citalopram given was 20mg and this was increased at weeks three, six and eight to a maximum of 60mg.

Patients were clinically evaluated at baseline and at weeks 1 through to 4 and at weeks 6, 8 and 10.

Overall, 11 patients completed the 10-week trial. No patient discontinued the treatment because of side effects and in those who completed the trial citalopram was well tolerated.

The patients appeared to require long-term treatment at relatively high doses to show a response. The mean dose used in the study was 37.3mg and the majority of patients responded to the treatment.

“Our open-label trial will hopefully provide dosing guidelines for a double-blind placebo-controlled study of citalopram in dysthymic patients,” said the team.

They believe that strategies encouraging dose escalation might be useful for treating patients with dysthymic disorder but caution that some of the responses seen in their study might have been due to naturally occurring euthymic periods rather than treatment.

Reference: Dunner et al, Depression and Anxiety 2002;15:18-22

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