• Home
  • Store
    • Newsletter Subscriptions
    • Multimedia Subscriptions
    • Books
    • eBooks
    • ABPN SA Courses
  • CME Center
  • Multimedia
    • Podcast
    • Webinars
    • Blog
  • Newsletters
    • General Psychiatry
    • Child Psychiatry
    • Addiction Treatment
    • Hospital Psychiatry
    • Geriatric Psychiatry
    • Psychotherapy and Social Work
  • Log In
  • Register
  • Welcome
  • Sign Out
  • Subscribe
Home » Citalopram Plus Stimulants for Chronic Irritability?

Citalopram Plus Stimulants for Chronic Irritability?

July 14, 2021
Eric Robbins, MD.
From The Carlat Child Psychiatry Report
Issue Links: Learning Objectives | Editorial Information | PDF of Issue
Eric Robbins, MD. Dr. Robbins has disclosed no relevant financial or other interests in any commercial companies pertaining to this educational activity.
REVIEW OF: Towbin K et al, J Am Acad Child Adolesc Psychiatry 2020;59(3):350–361

STUDY Type: Randomized controlled trial

Chronic irritability in youth is ever-present in daily practice. Currently called disruptive mood dysregulation disorder (DMDD) in the DSM-5, there is an ever-evolving debate about how to treat this condition, but no definitive conclusion. While there are some encouraging studies of parent management training and cognitive behavioral therapy for DMDD, this small but double-blind placebo-controlled study tried to illuminate possible pharmacological options.

The National Institute of Mental Health (NIMH) conducted an 8-week randomized controlled trial of 53 youth (ages 7–17 years old) with DMDD, in which 25 patients were randomized to stimulants plus adjunctive citalopram (Celexa), and 28 patients were randomized to stimulants plus placebo. The authors argued that since ADHD, anxiety, and depression are often comorbid with DMDD, methylphenidates and citalopram were chosen, although specific reasons for those choices were not noted. There was a 5-week lead-in phase in which all participants received stimulants. Children who remained symptomatic entered the randomized part of the trial. The average dosage of citalopram was 28.33 mg per day. Out of the 53 participants randomized to the trial, 8 did not complete it, 7 of whom withdrew assent during the study.

Citalopram significantly outperformed placebo on the primary outcome of Clinical Global Impression – Improvement (CGI-I): 35% vs 6% with an NNT of 3. However, there was no significant difference in secondary outcomes of Clinical Global Impression – Severity (CGI-S) and functional impairment. Both of these are markers of ongoing severity of condition and arguably more important markers of response, but neither showed statistically significant differences between the two groups.

CCPR’s Take
While therapy remains the first-line treatment for DMDD, methylphenidate may be of some help, and if the response is not adequate, citalopram may be a reasonable adjunct to try.
Child Psychiatry
KEYWORDS citalopram disruptive-mood-dysregulation-disorder-dmdd irritability
    Eric Robbins, MD.

    More from this author
    www.thecarlatreport.com
    Issue Date: July 14, 2021
    SUBSCRIBE NOW
    Table Of Contents
    CME Post-Test - Substance Use in Children and Adolescents, CCPR, July/August/September 2021
    Teen Drinking: Risks and Responses
    Addressing the Hazards of Performance-Enhancing Substances
    Citalopram Plus Stimulants for Chronic Irritability?
    SSRIs vs SNRIs in Pediatric Anxiety Disorders: Which Are More Tolerable?
    Is It Time for an Online Tantrum Tool?
    ADHD Prevalence in the US Black Population
    Note From the Editor-in-Chief
    Reading Research: Details Matter
    DOWNLOAD NOW
    Featured Book
    • PB4e_Cover2.png

      Psychiatry Practice Boosters, Fourth Edition (2023)

      Teaches you the key points of 63 of the most clinically relevant studies in psychiatry.
      READ MORE
    Featured Video
    • therapist_canstockphoto9201097.jpg
      General Psychiatry

      Using SAMe In Clinical Practice with Garrett Rossi, MD

      Read More
    Featured Podcast
    • autistic_suicidality.jpeg
      Child Psychiatry

      Addressing Suicidality in Autistic Children and Teens

      Autistic kids and teens can become despondent or suicidal. This episode explores the distinction between self-injurious behavior and suicidality in autistic children,...

      Listen now
    Recommended
    • Approaches to Autism Intervention

      January 31, 2022
      canstockphoto2240982_child-bubbles_thumb.jpg
    • Currently Available Cannabis Products

      September 1, 2022
    • Interpreting Assessment Discrepancies from Multiple Sources

      October 17, 2022
      ChildAssessment.png
    • Approaches to Autism Intervention

      January 31, 2022
      canstockphoto2240982_child-bubbles_thumb.jpg
    • Currently Available Cannabis Products

      September 1, 2022
    • Interpreting Assessment Discrepancies from Multiple Sources

      October 17, 2022
      ChildAssessment.png
    • Approaches to Autism Intervention

      January 31, 2022
      canstockphoto2240982_child-bubbles_thumb.jpg
    • Currently Available Cannabis Products

      September 1, 2022
    • Interpreting Assessment Discrepancies from Multiple Sources

      October 17, 2022
      ChildAssessment.png

    About

    • About Us
    • CME Center
    • FAQ
    • Contact Us

    Shop Online

    • Newsletters
    • Multimedia Subscriptions
    • Books
    • eBooks
    • ABPN Self-Assessment Courses

    Newsletters

    • The Carlat Psychiatry Report
    • The Carlat Child Psychiatry Report
    • The Carlat Addiction Treatment Report
    • The Carlat Hospital Psychiatry Report
    • The Carlat Geriatric Psychiatry Report
    • The Carlat Psychotherapy Report

    Contact

    info@thecarlatreport.com

    866-348-9279

    PO Box 626, Newburyport MA 01950

    Follow Us

    Please see our Terms and Conditions, Privacy Policy, Subscription Agreement, Use of Cookies, and Hardware/Software Requirements to view our website.

    © 2023 Carlat Publishing, LLC and Affiliates, All Rights Reserved.