Effects of Citalopram Treatment of Protracted Withdrawal (Syndrome of Anhedonia) in Patients with Heroin Addiction

Abstract

Objective Soon after termination of withdrawal, many detoxified heroin addiction patients experience affective instability (i.e., depression, dysphoria, anxiety), insomnia, and craving for opiates. Previously, the authors have described these symptoms as the syndrome of anhedonia (SA). The search for novel pharmacologic agents able to optimize treatment of this syndrome is an important component in the prevention of future relapses and stabilization of remissions. This study examines the new pharmacologic treatment of SA. The choice of antidepressants as possible medication for SA is based on the fact that depressive symptoms are the most prominent features of SA. The authors compare the effect of the selective serotonin reuptake inhibitor citalopram on SA with the tricyclic antidepressant amitriptyline and placebo. Methods Immediately after detoxification, 73 heroin addiction patients were randomly assigned to one of three groups: 26 patients received 20 mg/d citalopram during 3 weeks; 24 patients received 75 mg/d amitriptyline; and 23 patients received placebo. Results The results of the randomized, single-blind, placebo-controlled study showed that both medications, citalopram and amitriptyline, are more effective than placebo in treatment of SA. However, patients in the amitriptyline group reported a statistically greater number of side effects in comparison with patients in the two other groups. Conclusion Citalopram significantly reduces the severity of SA in patients with heroin addiction.