Is citicoline as effective as an SSRI for treating depression? Original paper

Stroke has a severe impact on multiple functional domains, including body function impairments, cognitive deficits, and activity limitations, which affect the patient’s quality of life and commonly lead to depression.^[1] Selective serotonin reuptake inhibitors (SSRIs) are frequently chosen for treating depression, and while effective, they can also have undesirable side effects.

Citicoline participates in the biosynthesis of phosphatidylcholine (the most abundant phospholipid in cell membranes) and the neurotransmitter acetylcholine and has been used to improve memory and behavior in cognitively impaired patients.^[2] Could citicoline be an effective alternative treatment for mood disorders?

This retrospective cohort study evaluated the effect of SSRIs and nootropic drugs (i.e., citicoline or choline alphoscerate) on anxiety and depressive symptoms in 44 poststroke patients (average age of 62) with depression. The patients were treated with an SSRI or 1000 milligrams of citicoline or 600 milligrams of choline alphoscerate daily for 6 months. The outcomes assessed were anxiety and depression measured by the Hamilton Anxiety Rating Scale (HAM-A) and Hamilton Depression Rating Scale (HAM-D).

Compared to baseline, there were improvements in anxiety and depression in both groups, with large effect sizes reported in the SSRI group and small effect sizes reported in the nootropic drug group. Improvements in the SSRI group were significantly higher compared to the nootropic drug group.

The SSRI group had significantly higher scores for anxiety and depression at baseline, which may have influenced the results. Due to the retrospective design, small sample size, and short follow-up, this study should be considered exploratory.