The efficacy of citalopram or escitalopram in patients with asthma and major depressive disorder

Catherine D Agarwal; Jayme M Palka; Alexander J Gajewski; David A Khan; E Sherwood Brown

doi:10.1016/j.anai.2023.11.004

The efficacy of citalopram or escitalopram in patients with asthma and major depressive disorder

Ann Allergy Asthma Immunol. 2024 Mar;132(3):374-382. doi: 10.1016/j.anai.2023.11.004. Epub 2023 Nov 11.

Authors

Catherine D Agarwal¹, Jayme M Palka¹, Alexander J Gajewski¹, David A Khan², E Sherwood Brown³

Affiliations

¹ Department of Psychiatry, The University of Texas Southwestern Medical Center, Dallas, Texas.
² Division of Allergy and Immunology, Department of Internal Medicine, The University of Texas Southwestern Medical Center, Dallas, Texas.
³ Department of Psychiatry, The University of Texas Southwestern Medical Center, Dallas, Texas; The Altshuler Center for Education and Research, Metrocare Services, Dallas, Texas. Electronic address: Sherwood.brown@UTSouthwestern.edu.

PMID: 37952772
DOI: 10.1016/j.anai.2023.11.004

Abstract

Background: Major depressive disorder is common in people with asthma. Yet, few studies have evaluated depression treatment in those with asthma.

Objective: To explore the relationship between antidepressant use, depressive symptoms, and asthma control, pooled data from 3 randomized trials of either citalopram or escitalopram were assessed.

Methods: Linear fixed effects and binary logistic regression analyses were conducted with between-subject covariates including treatment group, (original) study, and demographics. The within-subject effect of visit, and a treatment group-visit (between-within) interaction effect, were also evaluated. Analyses were repeated in a high asthma exacerbation subgroup having at least 3 oral corticosteroid bursts in the previous 12 months. Outcomes included the Hamilton rating scale for depression (HAM-D₁₇), the 7-item asthma control questionnaire (ACQ), and oral corticosteroid use (yes or no).

Results: In the pooled sample (n = 255), the antidepressant treatment group exhibited lower HAM-D₁₇ overall (P ≤ .001) and a lower likelihood for oral corticosteroid use (P ≤ .001) relative to the placebo group. In the high-exacerbation subgroup (n = 96), treatment group participants had lower overall asthma control questionnaire (P = .004) and HAM-D₁₇ scores (P ≤ .001), and a lower likelihood of oral corticosteroid use (P = .003), relative to placebo participants. All treatment group interaction effects were not significant.

Conclusion: Citalopram or escitalopram exhibited efficacy in reducing depressive symptoms and the need for rescue oral corticosteroids in patients with asthma and major depressive disorder. Future work should determine whether selective serotonin reuptake inhibitors are effective at improving asthma outcomes in those with asthma who are not depressed.

Trial registration: Clinicaltrials.gov Identifier: NCT00621946 and NCT01324700 (one study was conducted before ClinicalTrials.gov requirements).

MeSH terms

Adrenal Cortex Hormones / therapeutic use
Antidepressive Agents / therapeutic use
Asthma* / drug therapy
Citalopram* / therapeutic use
Depressive Disorder, Major* / drug therapy
Escitalopram* / therapeutic use
Humans
Randomized Controlled Trials as Topic
Treatment Outcome

Substances

Adrenal Cortex Hormones
Antidepressive Agents
Citalopram
Escitalopram

Associated data

ClinicalTrials.gov/NCT00621946
ClinicalTrials.gov/NCT01324700