Psychopharmacology (2002) 163:106–110DOI 10.1007/s00213-002-1151-x
O R I G I N A L I N V E S T I G A T I O N
Catherine J. Harmer · Zubin Bhagwagar ·Phillip J. Cowen · Guy M. Goodwin
Acute administration of citalopram facilitates memory consolidationin healthy volunteers
Received: 8 February 2002 / Accepted: 8 May 2002 / Published online: 29 June 2002 Springer-Verlag 2002
Abstract Objectives: Decreasing serotonergic neurotrans-
mission in humans has been found to impair memoryconsolidation. Such effects may be relevant to the
Serotonergic circuits have long been held to play a role in
memory deficits seen in major depression and the
learning and memory processes. However, results from
cognitive actions of antidepressant drugs used to treat
animal studies have yielded inconsistent findings con-
them. However, the improvement in cognitive function
cerning the direction of its effect (Altman and Normile
often found following successful pharmacological treat-
1988). While there is evidence that stimulation of
ment in depression may be confounded by symptom
serotonin activity impairs, whereas blockade of its
improvement. Rationale: The present study assessed the
activity enhances, learning and memory (see McEntee
effects of an acute challenge with the selective seroto-
and Crook 1991), the opposite findings have also been
nergic re-uptake inhibitor citalopram in healthy (non-
reported (e.g. Bammer 1982; Flood and Cherkin 1987).
depressed) females. Methods: Immediate and delayed
These inconsistencies may relate to interactions between
recall/recognition was assessed using the auditory verbal
the type of memory assessed, dose and specificity of
learning test following 10 mg (intravenous) citalopram or
agents used and the timing of the serotonergic manipu-
placebo in a double-blind between groups design.
Results: Immediate recall on the verbal memory test
In humans, decreasing serotonergic neurotransmission,
was unaffected by citalopram administration. However,
using the method of tryptophan depletion, has been
volunteers receiving citalopram showed enhanced long-
reported to decrease memory and learning (Park et al.
term memory performance in terms of delayed recall and
1994; Riedel et al. 1999; Schmitt et al. 2000). In
recognition relative to those receiving placebo. Sustained
particular, long-term, as opposed to short-term, memory
attention performance was also comparable in the two
appears to be primarily affected. In the study by Riedel et
groups of subjects suggesting that non-specific increases
al. (1999), immediate recall of verbal items was unaf-
in information processing are not responsible for this
fected by tryptophan depletion, but delayed recall and
effect. Conclusions: These results indicate that augmen-
recognition of these same items was significantly im-
tation of serotonergic neurotransmission is associated
paired. In a subsequent investigation, only tryptophan
with increased memory consolidation, which may be
depletion given prior to learning affected delayed recall.
relevant to its therapeutic and cognitive actions in acutely
Administration of the tryptophan-free drink 1 h after
presentation of a word list did not affect the storage orretrieval of this verbal material (Schmitt et al. 2000). The
Keywords SSRI · Citalopram · Memory consolidation ·
involvement of serotonin in memory does not appear to
be restricted to verbal material, as tryptophan depletionhas also been reported to impair performance in non-verbal memory tasks, such as paired associate learningand pattern recognition memory (Park et al. 1994;Rubinsztein et al. 2001).
A role for serotonin in learning and memory may be
relevant to clinical conditions such as depression, Alz-
)) · Z. Bhagwagar · P.J. Cowen · G.M. Goodwin
Neurosciences Building, University Department of Psychiatry,
heimer’s disease and the symptoms associated with prior
ecstasy (MDMA) use. Major depressive disorder has been
associated with impaired recall both on immediate and
delayed measures (Austin et al. 1992; Brown et al. 1994),
and memory deficits are usually seen to improve follow-
final learning trial), and recognition. Signal detection theory was
ing recovery from the disorder with antidepressant
applied to the data from the recognition test to derive a measure ofaccuracy corrected for the subject’s response tendency. The
treatment (Peselow et al. 1991), particularly selective
proportion of correctly recognized words (cr) and the proportion
serotonergic reuptake inhibitors (SSRIs) (Keegan et al.
of falsely recognized (fr) constitute the non-parametric sensitivity
1991; Bondareff et al. 2000). This improvement may be
measure: A’=1–1/4(fr/cr+(1–cr)/(1–fr)).
related to direct actions of the antidepressant on memoryor may be a non-specific effect of symptom improvement.
Similarly, deficits in immediate and delayed memoryhave been reported to occur in individuals with past
A measure of sustained attention was also given, adapted from a
history of ecstasy use with associated abnormalities of
test by Wesnes and Warburton (1984) and Sahakian et al. (1989). In
serotonergic functioning (e.g. Reneman et al. 2000,
this task, digits between 1 and 9 were presented in the centre of thescreen at a rate of 200 per minute (pseudo-random order) for 7 min.
Subjects were asked to monitor the digits for any one of three
The effects of increased, as opposed to decreased,
specified digit sequences (3–5–7, 2–4–6 or 4–6–8), which they
serotonin levels have not been investigated to the same
should respond to by pressing a button on a key pad. A practice
degree in humans. Such results may help confirm the role
session was given initially, with target sequences appearing in red,to familarise volunteers with the nature of the task. In the testing
of serotonin in memory processes and also provide a
phase all digits were given in black on a white screen. This task
possible mechanism for the cognitive effects of antide-
yields three measures: speed of correct detections, number of
pressant treatment in major depression. The present study
correct detections and responses made in the absence of appropriate
therefore investigated the effects of an acute challenge
stimuli (false alarms). Signal detection analysis can also be applied
with the SSRI, citalopram, on verbal short and long-term
to these results, giving two independent measures of performance:response sensitivity and response bias.
memory in non-depressed female subjects. Sustainedattention was also examined to assess whether moreglobal changes in information processing were found
following SSRI treatment. Based on the effects of
Subjective state was recorded using visual analogue scales for the
tryptophan depletion in humans, it was postulated that
following variables: happiness, sadness, fear, disgust, anger,
citalopram would specifically facilitate long-term mem-
alertness and anxiety. The Befindlichkeits scale (BFS: von Zerrsen
ory recall and recognition, without affecting immediate
et al. 1974) was also given to provide an additional measure of
Subjects attended the laboratory at midday, having fasted frombreakfast, and an IV cannula was inserted. After a 30-min rest
period subjects received infusion of either citalopram (10 mg, IV)or placebo given over 30 min. The immediate recall part of the
Twenty-four healthy female volunteers between the ages of 21 and
AVLT was given 45 min after the end of the infusion, by which
59 years took part in this study. Participants were screened to
time effects of citalopram on serotonin function have been reported
exclude those with a current or previous history of psychiatric
(Attenburrow et al. 2001). In between the distraction and delayed
disorder (assessed using semi-structured interview for DSM IV),
recall, subjects were given the sustained attention task. Subjective
current medication (apart from the contraceptive pill), current or
state was assessed at baseline and prior to the psychological testing.
previous substance use, or significant physical illness. All gavetheir written consent to participate in this study, which wasapproved by the local ethical committee. Volunteers were randomly
allocated to receive citalopram (10 mg, IV) or placebo in a double-blind between groups design. These two groups were matched in
Performance in these tasks was analysed using two-way split-plot
terms of age (mean age: 40.1€3.6 and 37.3€3.7 years, respectively)
analysis of variance (ANOVA), with group and learning trial as
and years of education (mean: 13.4€0.7; 14.6€0.7). All volunteers
factors (for immediate and delayed recall). Significant main effects
were tested within the follicular phase of their menstrual cycle.
were completed using simple main effect analyses. Recognitionmemory was analysed using one-way ANOVA.
The auditory verbal learning test assesses a number of different
components of learning, recall, and recognition (Rey 1964). In theimmediate recall phase, a 15-item word list was read to the subject
five times, and after each trial the subject was asked to repeat backas many items as they could remember in any order. Immediaterecall on a distracter list was then assessed, providing a short delay
Recall of the 15-item word list improved over the five
after which free recall of the original list was tested. Fifteen
repetitions in both groups of subjects [Fig. 1: main effect
minutes later, subjects were tested for long delay free recall,
of trial: F(4,88)=108.7, P<0.001]. However, there was no
followed by a recognition test, where they were asked to respond
effect of group or group by trial interaction in this
with a “Yes” or “No” to each item on a list comprising the 15targets plus 35 distractors. Data were analysed with respect to four
analysis (F<1, NS), suggesting that citalopram adminis-
dependent variables: learning over trials 1–5, short-delay and long-
tration had no effect on acquisition and short term recall.
delay free recall (expressed as a percentage of performance on the
Mean performance in the delayed recall and recognitioncomponent of the AVLT is given in Fig. 2. Recallfollowing the distracter [F(1,22)=6.6, P<0.05] and the 15-min delay [F(1,22)=5.1, P<0.05] was significantly facil-itated by citalopram administration. A facilitatory effectof citalopram on long-term memory was also seen in therecognition
Fig. 1 Immediate recall over the five learning trials following
There was no effect of citalopram on target sensitivity,
citalopram (black) or placebo (white). Values represent mean
response bias or reaction time on this measure of
The changes in memory occurred in the absence of anysubjective alterations in mood and anxiety, as judged bystandard visual analogue rating scales and the BFS scaleof mood changes (all comparisons, P>0.08).
Acute administration of citalopram was found to facilitatelong-term recall and recognition of verbal material in theabsence of effect on immediate recall in healthy females. These results are consistent with previous findings, whichsuggest decreased memory consolidation following re-duction of serotonin activity with tryptophan depletion inhealthy volunteers (Riedel et al 1999). These datatherefore indicate reciprocal effects of serotonin in long-term memory processes in humans. Citalopram adminis-tration did not affect sustained attention performance orsubjective ratings of mood and energy, suggesting that thememory effects are unlikely to represent a non-specificaction.
Results from animal studies have revealed inconsistent
Fig. 2 Delayed recall and recognition following citalopram (blackbars
findings concerning the role of serotonin in learning and
) or placebo (grey bars). Top graph: following distracter list
and 15-min delay. Values represent mean number of items recalled,
memory. However, in humans, tryptophan depletion,
expressed as a percentage of each subjects’ final score on the
acting to decrease serotonin neurotransmission, has
immediate recall component of the AVLT. Lower graph: recogni-
deleterious effects on memory consolidation. Using a
tion memory. Values represent signal detection score, A’ €1 SEM.
slightly different procedure from the one used here,
Asterisks represent statistical comparison of the two groups:*P<0.05
administration of a tryptophan free mixture prior tolearning was found to impair delayed recall and recog-nition at both 30 min and 18 h after list presentation,whilst leaving short-term memory intact (Riedel et al.
(with SD in brackets) in thesustained attention task follow-
1999). The present data directly mirror this pattern of
results: enhanced long-term, but not short-term, memoryperformance following citalopram. The present results
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