Citalopram, a specific inhibitor of serotonin reuptake in treatment of psychotic and borderline patients

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Abstract
The case histories of four psychotic patients and four borderline patients with chronic incapacitating impulsiveness, aggressivity, and anxiety are presented. Traditional therapeutic efforts were ineffective and unsuitable for these patients. Citalopram (20–60 mg/day) added to the previous neuroleptic treatment of the psychotic patients clearly improved the clinical condition of these patients, and a marked decrease in anxiety as well as in aggressive and impulsive behaviour was recorded. At the same time, the dose of neuroleptics could be reduced. No clinically significant adverse effects were noted in three of the psychotic patients, whereas neurologic side-effects were observed in one female patient. In the same manner anxiety symptoms and impulsive and uncontrolled behavioural traits were reduced in the borderline patients, and their psychosocial coping was clearly improved. Thus it seems obvious that in some so-called treatment-resistant psychiatric conditions marked especially by anxiety and aggressive and impulsive behaviour, the selective serotonin reuptake inhibitor citalopram is of therapeutic value. These findings stress the role of serotonin in these conditions, and further studies with carefully selected patients seem warranted.