Citalopram versus other antidepressants for depression
by ncbi.nlm.nih.gov
Major depression is a severe mental illness characterised by a persistent and unreactive low mood and loss of all interest and pleasure, usually accompanied by a range of symptoms including appetite change, sleep disturbance, fatigue, loss of energy, poor concentration, psychomotor symptoms, inappropriate guilt and morbid thoughts of death. Antidepressant drugs remain the mainstay of treatment in moderate?to?severe major depression. During the last 20 years, selective serotonin reuptake inhibitors (SSRIs) have progressively become the most commonly prescribed antidepressants. Citalopram, one of the first SSRIs introduced in the market, is the racemic mixture of S? and R?enantiomer. In the present review we assessed the evidence for the efficacy, acceptability and tolerability of citalopram in comparison with all other antidepressants in the acute?phase treatment of major depression. Thirty?seven randomised controlled trials (more than 6000 participants) were included in the present review. In terms of efficacy, citalopram was more efficacious than other reference compounds like paroxetine or reboxetine, but worse than escitalopram. In terms of side effects, citalopram was more acceptable than older antidepressants, like tricyclics. Based on these findings, we conclude that clinicians should focus on practical or clinically relevant considerations including differences in efficacy and side?effect profiles.
Abstract
Background: Recent US and UK clinical practice guidelines recommend that second?generation antidepressants should be considered amongst the best first?line options when drug therapy is indicated for a depressive episode. Systematic reviews have already highlighted some differences in efficacy between second?generation antidepressants. Citalopram, one of the first selective serotonin reuptake inhibitors (SSRI) introduced in the market, is one of these antidepressant drugs that clinicians use for routine depression care.
Objectives: To assess the evidence for the efficacy, acceptability and tolerability of citalopram in comparison with tricyclics, heterocyclics, other SSRIs and other conventional and non?conventional antidepressants in the acute?phase treatment of major depression.
Search methods: We searched The Cochrane Collaboration Depression, Anxiety and Neurosis Controlled Trials Register and the Cochrane Central Register of Controlled Trials up to February 2012. No language restriction was applied. We contacted pharmaceutical companies and experts in this field for supplemental data.
Selection criteria: Randomised controlled trials allocating patients with major depression to citalopram versus any other antidepressants.
Data collection and analysis: Two reviewers independently extracted data. Information extracted included study characteristics, participant characteristics, intervention details and outcome measures in terms of efficacy (the number of patients who responded or remitted), patient acceptability (the number of patients who failed to complete the study) and tolerability (side?effects).
Main results: Thirty?seven trials compared citalopram with other antidepressants (such as tricyclics, heterocyclics, SSRIs and other antidepressants, either conventional ones, such as mirtazapine, venlafaxine and reboxetine, or non?conventional, like hypericum). Citalopram was shown to be significantly less effective than escitalopram in achieving acute response (odds ratio (OR) 1.47, 95% confidence interval (CI) 1.08 to 2.02), but more effective than paroxetine (OR 0.65, 95% CI 0.44 to 0.96) and reboxetine (OR 0.63, 95% CI 0.43 to 0.91). Significantly fewer patients allocated to citalopram withdrew from trials due to adverse events compared with patients allocated to tricyclics (OR 0.54, 95% CI 0.38 to 0.78) and fewer patients allocated to citalopram reported at least one side effect than reboxetine or venlafaxine (OR 0.64, 95% CI 0.42 to 0.97 and OR 0.46, 95% CI 0.24 to 0.88, respectively).
Authors' conclusions: Some statistically significant differences between citalopram and other antidepressants for the acute phase treatment of major depression were found in terms of efficacy, tolerability and acceptability. Citalopram was more efficacious than paroxetine and reboxetine and more acceptable than tricyclics, reboxetine and venlafaxine, however, it seemed to be less efficacious than escitalopram. As with most systematic reviews in psychopharmacology, the potential for overestimation of treatment effect due to sponsorship bias and publication bias should be borne in mind when interpreting review findings. Economic analyses were not reported in the included studies, however, cost effectiveness information is needed in the field of antidepressant trials.
Source: https://www.ncbi.nlm.nih.gov/pubmedhealth/PMH0047318/
Friday, May 8, 2026
Buspirone Pricing Options: What Patients Can Expect to Pay for This Anxiety Medication
Buspirone has been available as a generic medication in the United States for decades, with the original Buspar brand largely absent from current pharmacy dispensing. Multiple manufacturers produce generic buspirone tablets, and the medication is consistently priced at the low end of the prescription drug cost spectrum due to its long generic history and high dispensing volume. Generic buspirone tablets are available in 5 mg, 7.5 mg, 10 mg, 15 mg, and 30 mg strengths. Cash prices for a 30-day supply vary by dose and pharmacy but are consistently low. Patients at standard therapeutic doses of 20 to 30 mg per day in divided doses can typically expect to pay between five and twenty dollars for a monthsupply at major retail pharmacies without insurance or discount programs. Because buspirone is dosed in divided daily doses rather than once daily like many psychiatric medications, the total tablet count per month is higher than for once-daily drugs, but the per-tablet cost is low enough that the total monthly cost remains modest within the typical generic pricing range. Prescription discount programs from free coupon services offer negotiated pharmacy pricing that can reduce out-of-pocket costs below standard retail rates. Patients who present an online discount card at the pharmacy counter typically secure the lowest available price. These programs work best when patients compare prices at two or three nearby pharmacies, as negotiated rates can vary across pharmacy networks. Several large retail pharmacy chains include generic buspirone in their fixed-price generic drug programs. For patients who refill buspirone monthly at a stable dose, these flat-fee programs provide predictable low cost per fill without the need to present a coupon card each time. Medicaid formularies include buspirone at the lowest cost tiers in nearly all state programs. Medicare Part D plans place generic buspirone in their lowest tier as well, resulting in minimal cost sharing for Medicare beneficiaries. For patients who have previously used benzodiazepines and are transitioning to buspirone, the cost difference is typically favorable. Benzodiazepines are also available generically at low cost, but buspirone avoids the controlled substance dispensing considerations that add logistical burden to benzodiazepine refills in many states. For patients who want to plan their medication costs and understand available pricing programs for their anxiety treatment, reviewing buspar-buspirone pricing options helps identify the most accessible and affordable path to consistent treatment. For patients comparing anxiety medication costs across drug classes and evaluating their options, anxiety medication category patient guides provides informative context across the treatment landscape.
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