BACKGROUND & AIMS: :Citalopram, an antidepressant whose use has become more widespread in Spain in recent years participates directly and indirectly in the lethal mechanism in voluntary and involuntary poisonings. There were 30 cases of autopsies in the Madrid region where citalopram and other psychoactive substances (psychotropic drugs, alcohol, opiates) were detected in the corpses. The postmortem citalopram levels in relation to the manner and mechanism of death were evaluated, and a significant difference between the toxic and nontoxic cases (p < 0.01) was found. We studied the citalopram blood levels alone and along with other psychoactive products, and these cases were then further divided into those where the compounds were at deadly levels and those which were not. We found a range of citalopram levels between 0.37 and 0.83 microg/mL in which some cases were associated with citalopram toxicity and others were not. Citalopram blood levels of less than 0.35 microg/mL did not lead to fatal poisoning when it was the sole substance detected.

背景与目标： 西酞普兰，一种抗抑郁药，近年来在西班牙的使用越来越广泛，直接和间接参与自愿和非自愿中毒的致死机制。马德里地区有30例尸体解剖，在尸体中检测到西酞普兰和其他精神活性物质 (精神药物，酒精，鸦片)。评估了死后西酞普兰水平与死亡方式和死亡机制的关系，发现毒性和无毒性病例之间存在显着差异 (p <0.01)。我们单独研究了西酞普兰的血液水平以及其他精神活性产品，然后将这些病例进一步分为化合物处于致命水平的病例和不处于致命水平的病例。我们发现西酞普兰水平范围在0.37至0.83微克/毫升之间，其中一些病例与西酞普兰毒性有关，而另一些病例与西酞普兰毒性无关。当西酞普兰是检测到的唯一物质时，低于0.35微克/毫升的血液水平不会导致致命中毒。

BACKGROUND & AIMS: OBJECTIVE:The objective of this study was to explore the efficacy of combination therapy with citalopram plus omega-3 fatty acids versus citalopram plus placebo (olive oil) in the initial treatment of individuals with major depressive disorder (MDD). We hypothesized that combination therapy would lead not only to greater efficacy but also to a more rapid onset of therapeutic response. METHODS:Forty-two subjects participated in this 9-week randomized, masked, placebo-controlled study of combination therapy (two 1 g capsules containing a blend of 900 mg of eicosapentaenoic acid, 200 mg of and docosahexaenoic acid, and 100 mg of other omega-3 fatty acids twice daily plus citalopram) versus monotherapy (two 1 g capsules of olive oil per day plus citalopram) treatment of MDD. RESULTS:The combination therapy demonstrated significantly greater improvement in Hamilton Depression Rating scale scores over time (F = 7.32; df 1,177; P = 0.008) beginning at week 4 (t = -2.48; df 177; P = 0.014). CONCLUSIONS:Combination therapy was more effective than monotherapy in decreasing signs and symptoms of MDD during the 8 weeks of active treatment; however, combination therapy did not seem to enhance the speed of the initial antidepressant response. These findings suggest that there may be an advantage to combining omega-3 fatty acids with a selective serotonin uptake inhibitor in the initial treatment of individuals with MDD. A larger definitive study is warranted.

背景与目标：

BACKGROUND & AIMS: OBJECTIVE:To compare within the framework of a novel pharmacopsychometric triangle, augmentation treatment with bupropion vs. buspirone in the acute therapy of major depression in the STAR*D study. The triangle provides a composite view in three domains of antidepressive activity, side effects, and quality of life. METHOD:Within the pharmacopsychometric triangle, the short six-item subscales of the Hamilton Depression Scale (HAM-D(17)) and of the Inventory of Depressive Symptomatology (IDS-C(30)), referred to as HAM-D(6) and IDS-C(6), were focussed on pure antidepressive effect. Side-effects (tolerable vs. intolerable) and quality of life were measured using patient-administered questionnaires. A modified intention to treat sample was used. RESULTS:Within the pharmacopsychometric triangle, bupropion-SR (sustained release) was superior to buspirone when augmented to the current citalopram treatment. Thus, in the domain of pure antidepressive effect, bupropion-SR was superior (P = 0.05) on the HAM-D(6), IDS-C(6), and IDS-C(30), but not on the HAM-D(17). In the domain of side effects, the total scores on the Patient Rated Inventory of Side Effects (PRISE) were reduced significantly more by bupropion-SR than by buspirone (P = 0.03). In the domain of quality of life, the total scores on the Quality of Life Enjoyment and Satisfaction Questionnaire (QLES-Q) showed a trend (P = 0.10) from baseline to endpoint of a superiority for bupropion-SR compared with buspirone. CONCLUSION:In all domains of the pharmacopsychometric triangle, bupropion-SR was superior to buspirone as augmentation therapy in depressed outpatients not responding to citalopram.

背景与目标：

BACKGROUND & AIMS: OBJECTIVE:Obsessive-compulsive disorder (OCD) is one of the chronic anxiety disorders that interfere with routine individual life, occupational and social functions. There is controversy about the first choice of treatment for OCD between medication and psychotherapy. AIM:the aim was to investigate the efficacy of eye movement desensitization and reprocessing (EMDR) compared with medication by citalopram in treatment of OCD. METHODS:This randomized controlled trial was carried out on 90 OCD patients that randomly were assigned into two groups. They either received therapeutic sessions of EMDR or citalopram during 12 weeks. Both groups blindly were evaluated by the Yale-Brown scale before and after the trial period. RESULTS:Pretreatment average Yale-Brown score of citalopram group was about 25.26 as well as 24.83 in EMDR group. The after treatment scores were 19.06 and 13.6, respectively. There was significant difference between the mean Yale-Brown scores of the two groups after treatment and EMDR was more effective than citalopram in improvement of OCD signs. CONCLUSION:It is concluded that although both therapeutic methods (EMDR and Citalopram) had significant effect in improving obsessive signs but it seems that in short term EMRD has better effect in improvement of final outcome of OCD.

背景与目标：

BACKGROUND & AIMS: BACKGROUND:Administration of 5-hydroxytryptamine (5HT) and selective 5HT receptor ligands modifies interdigestive motility in animals and in man. AIM:To study the effect of citalopram, a selective 5-HT reuptake inhibitor, on interdigestive motility in man. METHODS:In 20 healthy subjects, antroduodenojejunal motor activity was studied manometrically. Basal interdigestive motor activity was recorded until the passage of two activity fronts. Ten minutes after the second activity front, placebo or 20 mg of citalopram was administered intravenously in a double-blind randomized fashion. Recording continued until the passage of two more activity fronts had occurred. RESULTS:Administration of citalopram induced a premature small intestinal phase 3 after 35 +/- 6.4 min, compared to 120 +/- 17 min after placebo P < 0.01. Citalopram shortened MMC cycle length at the expense of phase 1 and phase 2 and significantly increased the motility index during phase 2 in the antrum and the small intestine. CONCLUSIONS:In the interdigestive state in man, intravenous administration of the selective 5-HT reuptake inhibitor citalopram induces a premature intestinal phase 3 and suppresses gastric activity fronts. Phase 2 motility is stimulated both in the stomach and in the small bowel after citalopram. These data suggest that 5HT is involved in the control of interdigestive motility.

背景与目标：

BACKGROUND & AIMS: BACKGROUND:Hyponatremia secondary to the syndrome of inappropriate secretion of antidiuretic hormone is an uncommon complication of treatment with the new class of antidepressant agents, the selective serotonin reuptake inhibitors. The risk of hyponatremia seems to be highest during the first weeks of treatment particularly, in elderly females and in patients with a lower body weight. CASE PRESENTATION:A 61-year-old diabetic male was admitted to the hospital because of malaise, progressive confusion, and a tonic/clonic seizure two weeks after starting citalopram, 20 mg/day. On physical examination the patient was euvolemic and had no evidence of malignancy, cardiac, renal, hepatic, adrenal or thyroid disease. Laboratory tests results revealed hyponatremia, serum hypoosmolality, urine hyperosmolarity, and an elevated urine sodium concentration, leading to the diagnosis of inappropriate secretion of antidiuretic hormone. Citalopram was discontinued and fluid restriction was instituted. The patient was discharged after serum sodium increased from 124 mmol/L to 134 mmol/L. Two weeks after discharge the patient denied any new seizures, confusion or malaise. At that time his serum sodium was 135 mmol/L. CONCLUSIONS:Because the use of serotonin reuptake inhibitors is becoming more popular among elderly depressed patients the present paper and other reported cases emphasize the need of greater awareness of the development of this serious complication and suggest that sodium serum levels should be monitored closely in elderly patients during treatment with citalopram.

背景与目标：

BACKGROUND & AIMS: OBJECTIVE:To report a case of serotonin syndrome associated with interaction between fentanyl and citalopram, as evidenced by medication history, clinical features and reversal following discontinuation of fentanyl. CASE SUMMARY:A 65-year-old patient chronically treated with the selective serotonin reuptake inhibitor (SSRI) citalopram developed confusion, agitation, tachycardia, tremors, myoclonic jerks and unsteady gait, consistent with serotonin syndrome, following initiation of fentanyl, and all symptoms and signs resolved following discontinuation of fentanyl. Based on the Naranjo probability scale, serotonin syndrome was a probable adverse reaction associated with co-administration of citalopram and fentanyl. DISCUSSION:Serotonin syndrome is a potentially lethal pharmacodynamic interaction between medications that increase serotonergic transmission at the synaptic junction. The development of new pharmacological agents with varied properties and actions has increased the risk of serotonin syndrome as a clinical diagnosis. SSRIs and fentanyl are commonly co-administered, especially in the setting of chronic or malignant pain, as underlying depression may contribute to the pathogenesis of pain. CONCLUSION:Healthcare professionals should be aware of the possible development of serotonin syndrome as a complication of initiation of fentanyl and other phenylpiperidine opioids in patients treated with SSRIs.

背景与目标：

BACKGROUND & AIMS: OBJECTIVE:The objective of this case report is to create awareness on restless legs syndrome (RLS) among clinicians working in emergency units. METHOD:We describe a case reporting important aggravation of RLS associated with citalopram, 60 mg/day, in a 48-year-old woman who was sent to the emergency unit by her general practitioner. Citalopram was replaced by bupropion, 150 mg/day, and sertraline, 50 mg/day. RESULTS:Three days later, symptoms of RLS started to diminish and, after 3 weeks, clinical symptoms had disappeared entirely. On 6-month follow-up, the patient did not manifest clinically significant RLS. Ignoring RLS could lead to a worsening of symptoms and could increase the risk for iatrogenic conditions. The prevalence of RLS in the general population is 3-9%; nevertheless, this syndrome is frequently underdiagnosed. CONCLUSION:This case report suggests that RLS could be considered as a possible "dopamine-dependent side effect" of selective serotonin reuptake inhibitors (SSRIs). Bupropion could potentially "correct" dopaminergic dysfunction in RLS, and sertraline appears to be the SSRI that provides the least risk of RLS by blocking dopamine reuptake.

背景与目标：

BACKGROUND & AIMS: OBJECTIVE:In a prospective, open-label pilot study in probable-Alzheimer disease (AD) outpatients, the authors investigated the efficacy of citalopram to reduce restless activity and aberrant motor behaviors. METHODS:Nineteen subjects were evaluated with Neuropsychiatric Inventory subscale and total scores. RESULTS:There was a significant decline in aberrant motor behaviors and overall behavior problems at 4, 8, and 12 weeks. CONCLUSION:This study provides initial evidence that citalopram may be effective in reducing aberrant motor behaviors in AD. However, because of the potential biases of an open-label study, these findings need to be confirmed in a larger, controlled trial.

背景与目标：

BACKGROUND & AIMS: :1. Regional distribution of the serotonin transport complex was studied in 12 different brain areas from human brains. The serotonin uptake complex was measured with 3H-paroxetine, and 3H-imipramine. The binding site density was highest in the nucleus of raphé, medium in the basal ganglia, and lowest in cortical areas. The specific binding measured with 3H-paroxetine and 3H-citalopram was compared with the high affinity 3H-imipramine binding determined with either 100 microM 5HT or 1 microM imipramine as non specific displacers. 3H-paroxetine and 3H-citalopram allowed a more precise determination of Bmax, and are both good ligands for the serotonin uptake site, but the determinations with 3H-imipramine were within the same range. 2. Protease digestion of brain membranes showed that the binding site measured with all three ligands disappeared with the same rate as other membrane proteins, and not faster as might be expected from the literature. 3. Left/right hemisphere distribution was measured in cortical tissue from 6 brains using 3H-paroxetine. No difference between the two hemispheres was found. In one brain from a lithium treated patient a very low binding was measured, possibly indicating that the lithium treatment had decreased the serotonin uptake mechanism.

背景与目标： : 1。在人类大脑的12个不同大脑区域中研究了5-羟色胺转运复合物的区域分布。用3h-帕罗西汀和3h-丙咪嗪测量5-羟色胺摄取复合物。结合位点密度在raphh é 核中最高，在基底神经节中中等，在皮质区域中最低。将用3h-帕罗西汀和3h-西酞普兰测量的特异性结合与用100 microm5ht或1 microM丙咪嗪作为非特异性置换物测定的高亲和力3h-丙咪嗪结合进行比较。3h-帕罗西汀和3h-西酞普兰可以更精确地测定Bmax，并且都是5-羟色胺摄取位点的良好配体，但是3h-丙咪嗪的测定在相同范围内。2.脑膜的蛋白酶消化表明，用所有三个配体测量的结合位点以与其他膜蛋白相同的速率消失，并且不像文献中预期的那样快。3.使用3h-帕罗西汀测量6个大脑皮质组织中的左/右半球分布。没有发现两个半球之间的差异。在接受锂治疗的患者的一个大脑中，测量到非常低的结合，这可能表明锂治疗降低了5-羟色胺的摄取机制。

BACKGROUND & AIMS: :Reversal of chronic mild stress (CMS)-induced decrease of sucrose consumption has been studied in rats after 2, 7, 14, and 35 days treatment with imipramine, citalopram (both 10 mg/kg per day, i.p.), WAY 100635 (0.2 mg/kg sc, b.i.d.), and citalopram plus WAY 100635. Bmax, Kd, and functional status [cyclic AMP (cAMP) generation] of beta1-adrenoceptors were assessed in cortical tissue at the same time points. Citalopram reversed CMS-induced reduction of sucrose intake at an earlier time point than imipramine. WAY 100635 was not effective and did not potentiate the effect of citalopram. CMS produced increase of Bmax. Imipramine decreased Bmax in controls (Days 2, 7, 14, and 35) and normalised Bmax in stressed animals (Day 35). Citalopram, WAY 100635, and the combination increased Bmax in stressed animals and controls (Days 14 and 35). Inconsistent changes of Kd values and of cAMP responses to noradrenaline (NA) stimulation were observed. Thus stress- and drug-induced effects on beta1-adrenoceptors do not appear to be a common biochemical marker of antidepressant-like activity in the CMS model.

背景与目标： : 在用丙咪嗪，西酞普兰 (每天10 mg/kg，i.p.)，100635 (0.2 mg/kg sc，b.i.d.) 和西酞普兰加路100635。在同一时间点评估皮质组织中beta1-adrenoceptors的Bmax，Kd和功能状态 [循环AMP (cAMP) 生成]。西酞普兰在比丙咪嗪更早的时间点逆转了CMS诱导的蔗糖摄入量减少。方法100635无效，也不能增强西酞普兰的作用。CMS增加了Bmax。丙咪嗪降低了对照组 (第2、7、14和35天) 的Bmax，并使应激动物的Bmax正常化 (第35天)。西酞普兰、方式100635和组合增加了应激动物和对照组的Bmax (第14和35天)。观察到Kd值和cAMP对去甲肾上腺素 (NA) 刺激的反应变化不一致。因此，在CMS模型中，压力和药物诱导的对beta1-adrenoceptors的作用似乎不是抗抑郁药样活性的常见生化标记。

BACKGROUND & AIMS: :Clinical trials have shown better efficacy of escitalopram over citalopram, and review-based economic models the cost-effectiveness of escitalopram vs. citalopram (brand and generic). No head-to-head clinical trial has, however, evaluated the cost-effectiveness of both drugs so far. The aim of this study was to assess the relative cost-effectiveness of escitalopram compared with citalopram in patients with major depressive disorder. An economic evaluation was conducted alongside a double-blind randomized clinical trial conducted by general practitioners and psychiatrists comparing fixed doses of escitalopram (20 mg/day) or citalopram (40 mg/day) over 8 weeks in ambulatory care patients with major depressive disorder (baseline Montgomery-Asberg Depression Rating Scale score > or =30). Resources use was recorded using a standardized form recording use of healthcare services and days of sick leave for the 2-month prestudy period and for the 8-week study period. Statistically significant improvements were observed in patients treated with escitalopram. Mean per-patient costs for the escitalopram group, compared with the citalopram group, were 41% lower (96 euro vs. 163 euro; P<0.05) from a healthcare perspective. Differences were mostly related to lower hospitalization costs for escitalopram compared with citalopram recipients, assuming a parity price between escitalopram and citalopram. Bootstrapped distributions of the cost-effectiveness ratios also showed better effectiveness and lower costs for escitalopram compared with citalopram. Escitalopram is significantly more effective than citalopram, and is associated with lower healthcare costs. This prospective economic analysis demonstrated that escitalopram is a cost-effective first-line treatment option for major depressive disorder.

背景与目标： : 临床试验表明，艾司西酞普兰的疗效优于西酞普兰，并且基于回顾的经济模型可以证明艾司西酞普兰与西酞普兰 (品牌和通用) 的成本效益。然而，到目前为止，还没有正面的临床试验评估这两种药物的成本效益。这项研究的目的是评估艾司西酞普兰与西酞普兰在重度抑郁症患者中的相对成本效益。与全科医生和精神科医生进行的双盲随机临床试验一起进行了经济评估，比较了8周内固定剂量的艾司西酞普兰 (20 mg/天) 或西酞普兰 (40 mg/天) 对患有严重抑郁症的门诊患者 (基线Montgomery-Asberg抑郁量表评分> 或 = 30)。使用标准化表格记录资源使用情况，记录2个月前研究期间和8周研究期间的医疗服务使用情况和病假天数。在使用艾司西酞普兰治疗的患者中观察到统计学上的显着改善。从医疗保健的角度来看，与西酞普兰组相比，艾司西酞普兰组的平均每位患者费用41% 低 (96欧元对163欧元; P<0.05)。假设艾司西酞普兰和西酞普兰之间的平价价格与西酞普兰接受者相比，差异主要与艾司西酞普兰的住院费用较低有关。与西酞普兰相比，成本效益比的自举分布也显示出艾司西酞普兰更好的效果和更低的成本。艾司西酞普兰比西酞普兰有效得多，并且与较低的医疗保健成本相关。这项前瞻性经济分析表明，艾司西酞普兰是治疗重度抑郁症的一种经济有效的一线治疗选择。

BACKGROUND & AIMS: :A 35-year-old caucasian woman who suffered from major depression with marked psychomotor symptoms was treated with a selective serotonin re-uptake inhibitor (SSRI), citalopram. After 16 months successful treatment, the medication was gradually discontinued. One week after stopping citalopram, she experienced lowered mood and unnatural slowness in her movements. These symptoms were associated with low striatal dopamine (DA) activity as measured with baseline and follow-up [(18)F]DOPA PET scans. We suggest that stimulation of serotonergic system in the brain increases dopaminergic activity in the striatum. After cessation of this stimulation, striatal dopaminergic activity may decrease considerably in vulnerable patients and cause transient emotional and psychomotor discontinuation symptoms that disappear spontaneously in a few weeks.

背景与目标： : 一名35岁的白人妇女患有严重抑郁症，并伴有明显的精神运动症状，接受了选择性5-羟色胺再摄取抑制剂 (SSRI) 西酞普兰的治疗。成功治疗16个月后，逐渐停药。停用西酞普兰一周后，她的情绪低落，动作不自然。这些症状与基线和随访 [(18)F] 多巴PET扫描测量的低纹状体多巴胺 (DA) 活性相关。我们建议大脑中血清素能系统的刺激增加纹状体中的多巴胺能活性。在这种刺激停止后，脆弱患者的纹状体多巴胺能活性可能会大大降低，并引起短暂的情绪和精神运动中止症状，这些症状在几周内自发消失。

BACKGROUND & AIMS: :In a double-blind clinical trial comprising 29 depressed patients citalopram, a highly selective 5-HT re-uptake inhibitor and maprotiline, a specific NA re-uptake inhibitor, were compared. Allowing for the small sample and taking into consideration that both groups consisted of severely ill, hospitalized patients, it is notable that half of them appeared to respond to treatment. Comparison of the clinical efficacy of the two drugs showed no significant difference, but the profiles of the side-effects appeared to be different. The patients treated with citalopram showed increased sweating, drowsiness, restlessness and headache. These side-effects were almost entirely reported by the non-responders. The maprotiline patients had anticholinergic symptoms, such as dryness of mouth and constipation, side-effects which were also reported by the responders. No correlation was found between plasma steady-state levels of either drug and clinical outcome. The Dexamethasone Suppression Test (DST) appeared to show some predictive value as regards treatment response. There was a tendency towards better overall treatment results in the non-suppressor group. Determination of post-probenecid 5-HIAA, HVA and MHPG concentrations in lumbar-CSF was made in 22 patients. There was a significant negative correlation between HVA and the severity of depression, as well as a significant negative correlation of MHPG with the Newcastle score. The 5-HIAA concentration was found to be correlated with HVA, but not with MHPG. Rather surprisingly significant negative correlation between 5-HIAA and treatment results with maprotiline was found, but no correlation with MHPG. The lumbar-CSF MHPG and HVA values did not appear to have any predictive value as regards treatment response to citalopram or maprotiline. As expected the serotonin (5-HT) concentration in blood and thrombocytes in patients treated with citalopram showed a highly significant reduction after 2 and 4 weeks of treatment.

背景与目标： : 在一项包括29名抑郁症患者的双盲临床试验中，比较了高选择性5-HT再摄取抑制剂西酞普兰和特定NA再摄取抑制剂马普替林。考虑到少量样本，并考虑到两组均由重症住院患者组成，值得注意的是，其中一半似乎对治疗有反应。两种药物的临床疗效比较无显着差异，但副作用却有所不同。接受西酞普兰治疗的患者出汗，嗜睡，躁动和头痛增加。这些副作用几乎完全由无反应者报告。马普替林患者具有抗胆碱能症状，例如口干和便秘，反应者也报告了副作用。两种药物的血浆稳态水平与临床结果之间均未发现相关性。地塞米松抑制试验 (DST) 似乎对治疗反应具有一定的预测价值。在非抑制性组中，总体治疗结果有更好的趋势。对22例患者进行了腰椎脑脊液中丙磺舒后5-HIAA，HVA和MHPG浓度的测定。HVA与抑郁严重程度呈显著负相关，MHPG与纽卡斯尔评分呈显著负相关。发现5-HIAA浓度与HVA相关，但与MHPG无关。令人惊讶的是，发现5-HIAA与马普替宁的治疗结果之间存在显着的负相关，但与MHPG没有相关性。关于西酞普兰或马普替林的治疗反应，腰椎-CSF MHPG和HVA值似乎没有任何预测价值。正如预期的那样，西酞普兰治疗的患者血液和血小板中的5-羟色胺 (5-HT) 浓度在治疗2周和4周后显示出显着降低。

BACKGROUND & AIMS: :Recently, both the manufacturer of citalopram and the US Food and Drug Administration have warned health care providers and patients about new information implicating drug-induced QTc interval prolongation and torsade de pointes when using citalopram in doses >40 mg/day. This warning is not placed in the context of either benefits or risks in real-world clinical practice, leaving clinicians with an untenable choice between depriving patients of high-dose citalopram or malpractice litigation. We reviewed the literature and found no cases of citalopram-induced sudden cardiac death among patients taking up to 60 mg/day of citalopram and free of risk factors for QTc interval prolongation and torsade de pointes. Because psychotropic drug-induced sudden cardiac death is an outlier in the absence of identified risk factors for QTc interval prolongation and torsade de pointes, we do not believe current Phase 3 and Phase 4 studies provide sufficient information to limit current prescribing practices for citalopram (20 mg to 60 mg/day). We urge drug manufacturers and regulatory agencies to periodically publish full case reports of psychotropic drug-induced QTc interval prolongation, torsade de pointes, and sudden cardiac death so that clinicians and investigators may better understand the clinical implications of prescribing such drugs as citalopram.

背景与目标： : 最近，西酞普兰的制造商和美国食品药品监督管理局都警告医疗保健提供者和患者，当使用剂量> 40 mg/天的西酞普兰时，有关药物诱导的QTc间隔延长和尖端扭转型的新信息。在现实世界的临床实践中，这一警告没有被置于益处或风险的背景下，使临床医生在剥夺患者大剂量西酞普兰或医疗事故诉讼之间做出了站不住脚的选择。我们回顾了文献，发现服用西酞普兰高达60 mg/天的患者中没有西酞普兰诱发的心源性猝死病例，并且没有QTc间隔延长和尖端扭转型的危险因素。由于在没有确定的QTc间隔延长和尖端扭转型风险因素的情况下，精神药物引起的心脏猝死是一个异常值，因此我们认为当前的第3阶段和第4阶段研究无法提供足够的信息来限制当前西酞普兰的处方实践 (20 mg至60 mg/天)。我们敦促药品制造商和监管机构定期发布精神药物引起的QTc间期延长，尖端扭转型和心脏性猝死的完整病例报告，以便临床医生和研究人员更好地了解西酞普兰等药物的临床意义。