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Adding citalopram to stimulants may benefit youth with severe irritability

Youth unresponsive to stimulant medication alone saw greater improvement in severe irritability symptoms when they received add-on citalopram than those who received add-on placebo, according to double-blind randomized placebo-controlled trial results.

“Despite the increasing recognition of the importance of irritability, rigorous testing of possible treatments is still at a nascent state,” Kenneth Towbin, MD, from the mood brain and development unit, Emotion and Development Branch at the NIMH, and colleagues wrote.

Researchers examined the effectiveness of methylphenidate (MPH) plus citalopram (CTP) in the treatment of chronic severe irritability in 49 children aged 7 to 17 years with disruptive mood dysregulation disorder. After a lead-in phase of open treatment with stimulant, participants were randomly assigned to receive citalopram or placebo for 8 weeks.

The primary outcome was treatment response. Participants were assessed via the Clinical Global Impression’s Improvement (CGI-I) and Severity (CGI-S) scales, the Children’s Global Assessment of Severity (CGAS), the Pediatric Anxiety Rating Scale (PARS) and the Children’s Depression Rating Scale (CDRS).

The results showed that after 8 weeks, more participants who received methylphenidate plus citalopram responded to treatment than those who received methylphenidate plus placebo (35% vs. 6%; OR = 11.7; 95% CI = 2-68.16).

Although the difference in irritability severity between groups was nonsignificant at week 8, the investigators observed a significant group-by-week interaction occurred across the 8 weeks of the trial (b = –0.11; 95% CI, –0.21 to –0.002). Towbin and colleagues explained that changes in the severity of temper outbursts was the main driver of this difference.

In addition, there were no differences in functional impairment or depressive symptom severity between groups at the end of the trial no were there any differences in adverse effects, according to the study. No participants exhibited symptoms of hypomania or mania.

“This is the first [randomized controlled trial] of [a serotonin reuptake inhibitor] for the treatment of irritability in youth,” the researchers wrote. “Our results provide some support for the efficacy of CTP+MPH in the treatment of irritability in children with severe irritability who are already receiving methylphenidate. However, it is important to note that there were no differences in functional impairment between groups at the end of the trial.” – by Savannah Demko

Disclosure: The authors report no relevant financial disclosures.