Citalopram Titration in Early Non-responder Patients With Major Depressive Disorders

Citalopram Titration in Early Non-responder Patients With Major Depressive Disorders: a Pilot Study (CRY-MOOD)

Major depressive disorder is a common mental disorder and the leading cause of disability worldwide. According to the Canadian Network for Mood and Anxiety Treatment, early improvement following an antidepressant treatment is correlated with response and remission. Escalation of an antidepressant dose after 2 weeks, as opposed to 4 to 8 weeks, is proposed to favor early improvement. However, this has never been tested systematically in a controlled study involving major depressive disorder patients that are non-responders to their antidepressant treatment.

The investigators sought to assess whether it is feasible to perform a prospective randomized controlled double-blind feasibility study with a 2 week run-in period and 3 parallel groups randomized controlled study using citalopram. Citalopram has physicochemical properties compatible with over-encapsulation and a has a simple titration that allows the study of early dose increase.. It is among the most prescribed antidepressant in the province of Quebec and at the Hospital Maisonneuve-Rosemont - University family medicine group (U-FMG).

Since establishment of a randomized controlled trial is complex and expensive, a feasibility design is appropriate to identify all the obstacles and to minimize sources of possible bias (recruitment, follow up, resources).

Inclusion Criteria:

• Understand french or english
• Primary diagnostic of major depressive disorder based on the Diagnostic and Statistical Manual of Mental Disorders criteria (5th edition)
• Prescription of citalopram
• Citalopram started less than 4 days ago
• Able to receive informed consent
• Not participating to another study

Exclusion Criteria:

• Pregnancy or breastfeeding
• Unable to participate to follow-up
• Hypersensitivity to citalopram or any component of the formulation
• Known QT interval prolongation or congenital long QT syndrome
• Hepatic impairment (Child Pugh A, B or C)
• Renal impairment (Clcr < 30 ml/min)
• Known cytochrome P450 2C19 poor metabolizers
• History of non-response to citalopram
• Head trauma or severe cognitive impairment
• Substance-related and addictive disorders controlled less than 3 months or uncontrolled
• Schizophrenia or psychotic disorder
• Mixed depression
• History of manic/hypomanic episodes
• Use of prohibited drugs : monoamine oxidase inhibitors, cytochrome P450 2C19 inhibitors, drugs at risk of causing prolongation of the QT interval, cimetidine, pimozide and antidepressors taken for another psychiatric condition.