Paroxetine versus citalopram treatment of pathological crying after brain injury

Brain Inj. 1999 Oct;13(10):805-11. doi: 10.1080/026990599121197.


Selective serotonin reuptake inhibitors (SSRIs) are the treatment of choice for pathological crying after brain injury, independent of accompanying depression. In a series of 26 consecutive patients with acquired brain damage and episodes of involuntary crying, the efficacy and tolerability of paroxetine and citalopram were compared. The severity of pathological crying or laughing was rated based on clinical interviews with symptom provocation. The first 13 patients were treated with paroxetine and another 13 patients received citalopram in single daily doses of 10 to 40 mg. Rapid onset (within 1-3 days) and highly significant (p < 0.001) improvements of emotionalism were observed after both paroxetine and citalopram. There were no efficacy differences, despite the longer symptom duration in the citalopram group. The only adverse effect after paroxetine was nausea, which was reversible, in two patients, and nausea with vomiting in another two patients, who were switched to citalopram. Citalopram was tolerated without adverse effects.

Publication types

  • Clinical Trial
  • Comparative Study
  • Controlled Clinical Trial

MeSH terms

  • Adult
  • Aged
  • Brain Damage, Chronic / psychology
  • Brain Damage, Chronic / rehabilitation*
  • Brain Injuries / psychology
  • Brain Injuries / rehabilitation*
  • Citalopram / adverse effects
  • Citalopram / therapeutic use*
  • Crying*
  • Dose-Response Relationship, Drug
  • Drug Administration Schedule
  • Female
  • Humans
  • Laughter
  • Male
  • Middle Aged
  • Neuropsychological Tests
  • Paroxetine / adverse effects
  • Paroxetine / therapeutic use*
  • Prospective Studies
  • Serotonin Uptake Inhibitors / adverse effects
  • Serotonin Uptake Inhibitors / therapeutic use*
  • Treatment Outcome


  • Serotonin Uptake Inhibitors
  • Citalopram
  • Paroxetine