Abstract: AIM:To explore the clinical efficacy and safety of citalopram combined with doxepin in the treatment of generalized anxiety disorder (GAD). METHODS:The combination group was treated with citalopram (20 mg/d)and doxepin(75-125 mg/d), as the same period the other group was treated with venlafaxine, then the scores before and after 1, 2, 4, 6 weeks treatment were assessed by Hamilton Anxiety Scale (HAMA), the clinical efficacy after 6 weeks treatment using baseline reducing rate was assessed, and the adverse reaction incidence was assessed by using the TESS.RESULTS:After 6 weeks, 50 patients completed the treatment in combination group, and 30 patients completed the treatment in venlafaxine group. The expulsion rates were 10.7% and 9.1% respectively, P=0.70.The baseline reducing rate did not show any significant difference, the efficient rates were 92.0% and 93.3%, P=0.83.The effect of two methods had no significant difference through the Ridit value comparison.The psychosis anxiety factors showed conspicuous and most conspicuous difference during 4-6 weeks through HAM.The target symptoms factors were analyzed, the symptoms of insomnia, dysmnesia attention dysfunction and respiratory system of combination group were much improved(P<0.05 or 0.01)compared with the venlafaxine group.The adverse reaction was analyzed by SS collection, it showed the patients in combination group had more dry mouths, constipation and weight gain.CONCLUSION:Citalopra combined with doxepin showed the same clinical efficacy as the SNRIs and more safety, during the treatment of GAD, the treating cost would be less than 13 of the venlafaxine.It was a more practical way in treatment for the patients with lower income.

Key words: generalized anxiety disorder, citalopram, doxepin, therapeutic alliance