Donald Goff1,2, Jijun Wang3, Oliver Freudenreich4, Chenxiang Li5, Andrea Troxel5, Botao Zeng6, Renrong Wu7, Corinne Cather5, Babak Ardekani1,2, Daphne Holt5, Iruma Bello8, Yingping Zhao7; 1Department of Psychiatry, New York University School of Medicine, New York, 2Nathan Kline Institute for Psychiatric Research, Orangeburg, NY, 3Shanghai Mental Health Center, Jiaotong University School of Medicine, Shanghai, China, 4Department of Psychiatry, Massachusetts General Hospital, Harvard Medical School, Boston, 5Department of Population Health, Division of Biostatistics, New York University School of Medicine, New York, 6Qingdao Mental Health Center, Qingdao, China, 7The Second Xiangya Hospital of Central South University, Changsha, China, 8Department of Psychiatry, Columbia University, New York State Psychiatric Institute, New York
To determine whether add-on citalopram would improve negative and depressive symptoms in individuals with nonaffective first episode psychosis (FEP), we conducted a 12 month, placebo-controlled trial at sites in Boston, New York, Shanghai and Changsha, China. Ninety five individuals with FEP treated with second generation antipsychotics for 4-16 weeks and without significant depressive symptoms (CDSS score < 7) were randomized to add-on treatment with citalopram 40 mg/day or placebo; all participants received 24 sessions of psychoeducation. Fifty-one participants (54%) completed the 12 month trial. Mixed effects area under the curve (AUC) analysis revealed a significant reduction in ratings of depression (CDSS) in the placebo group compared to citalopram (p= .02). Negative symptoms were reduced with citalopram compared to placebo (p=.04); among the four SANS subscales, only the avolition subscale significantly improved with citalopram versus placebo (p= .002). The effect size of citalopram versus placebo on negative symptoms (SANS total) was .32 for participants with a duration of untreated psychosis (DUP) of less than 18 weeks (median split) and .52 for participants with a DUP greater than 18 weeks. Sexual side effects were more common with citalopram than placebo, but the overall mean number of treatment-emergent side effects was not increased with citalopram. Conclusion: In FEP patients without clinically-significant depression at baseline, citalopram reduced levels of negative symptoms, particularly in participants with long DUP, but depressive symptoms improved more with placebo.
