Effects of citalopram on worry and brain activation in patients with generalized anxiety disorder

Psychiatry Res. 2004 May 30;131(1):11-21. doi: 10.1016/j.pscychresns.2004.02.003.


The effects of auditory statements describing a personal worry on brain activation as measured by functional magnetic resonance imaging were examined in patients with generalized anxiety disorder (GAD) before and after anxiety reduction with citalopram. Six patients were imaged while listening to verbal descriptions of a personal worry or a neutral statement before treatment with citalopram and after 7 weeks of treatment. Pre-post drug analyses showed treatment with citalopram reduced self-reported anxiety and reduced BOLD responses to a pathology-specific worry and a neutral stimulus. After treatment, worry sentences, compared to neutral statements, elicit reduced BOLD responses in prefrontal regions, the striatum, insula and paralimbic regions. In addition, contrasts before and after treatment revealed reductions in the differential response that existed between worry and neutral statements. Overall reduction of BOLD response was most prominent during neutral statements, particularly in the left hemisphere. These findings support the clinical impression that GAD patients overreact to both pathology-specific and non-specific cues and that the reduction of anxiety attenuates the response to both types of cues.

Publication types

  • Research Support, Non-U.S. Gov't

MeSH terms

  • Adult
  • Anti-Anxiety Agents / adverse effects
  • Anti-Anxiety Agents / therapeutic use*
  • Anxiety Disorders / drug therapy*
  • Anxiety Disorders / physiopathology
  • Anxiety Disorders / psychology
  • Arousal / drug effects*
  • Brain / drug effects*
  • Brain / physiopathology
  • Brain Mapping
  • Citalopram / adverse effects
  • Citalopram / therapeutic use*
  • Dose-Response Relationship, Drug
  • Drug Administration Schedule
  • Female
  • Humans
  • Image Enhancement*
  • Image Processing, Computer-Assisted*
  • Limbic System / drug effects
  • Limbic System / physiopathology
  • Magnetic Resonance Imaging*
  • Male
  • Prefrontal Cortex / drug effects
  • Prefrontal Cortex / physiopathology
  • Serotonin Uptake Inhibitors / adverse effects
  • Serotonin Uptake Inhibitors / therapeutic use*
  • Speech Perception / drug effects
  • Speech Perception / physiology
  • Treatment Outcome


  • Anti-Anxiety Agents
  • Serotonin Uptake Inhibitors
  • Citalopram