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Boosting Fluoxetine As Effective As Adding Lithium Or Desipramine For Unresponsive Depression
A DGReview of :"Double-Blind Study of High-Dose Fluoxetine Versus Lithium or Desipramine Augmentation of Fluoxetine in Partial Responders and Nonresponders to Fluoxetine"
Journal of Clinical Psychopharmacology
08/30/2002
By Andrew A. Skolnick
Boosting the dosage of fluoxetine is as effective as adding either lithium or desipramine in treating depression that doesn't respond adequately to fluoxetine.
Maurizio Fava, MD, at the Massachusetts General Hospital in Boston, United States, and colleagues conducted a double blind clinical trial involving 101 outpatients with major depressive disorder, who either didn't respond or failed to respond adequately to eight weeks of treatment with fluoxetine 20 mg a day.
The 52 men and 49 women were randomized to received either four weeks of treatment with high-dose fluoxetine (40-60 mg/day), fluoxetine plus lithium (300-600 mg/day), or fluoxetine plus desipramine (25-50 mg/day).
The researchers found no significant difference in response rates across the three treatment groups. Forty-two percent of patients responded on high-dose fluoxetine, 29 percent responded on fluoxetine plus desipramine, and 23 percent responded on fluoxetine plus lithium, they reported.
There were also no significant differences in response rates for the three treatment groups among either the 49 partial responders or 52 nonresponders.
There were no significant relationships between lithium or desipramine blood levels and degree of improvement, as measured by the change in HAM-D-17 score, the investigators noted.
Dropout rates also were comparable, ranging from 9.1 percent for patients receiving high-dose fluoxetine to 14.7 percent for patients in the other two treatment groups.
"We found no significant differences in efficacy among these three treatment strategies among patients who had failed to respond adequately to eight weeks of treatment with fluoxetine 20 mg/day, although the high-fluoxetine group was associated with nonsignificantly higher response rates in both partial responders and nonresponders," the researchers concluded.
J Clin Psychopharmacol 2002; 22: 379-387
"Double-Blind Study of High-Dose Fluoxetine Versus Lithium or Desipramine Augmentation of Fluoxetine in Partial Responders and Nonresponders to Fluoxetine"
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