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Fluoxetine Treatment For Depression Should Continue For Set Period For Proper Assessment
A DGReview of :"When should a trial of fluoxetine for major depression be declared failed?"
American Journal of Psychiatry
04/09/2003
By David Ball
Patients with major depression who are being treated with fluoxetine should continue therapy for eight weeks before non-response is pronounced, say researchers in the United States.
Little is known about how long it takes for the widely used newer antidepressants to show their full effect so trial length should be discussed by clinicians and their patients at the start of therapy. This is suggested by F. M. Quitkin and colleagues at the Columbia University, New York State Psychiatric Institute.
In their 12-week open trial of fluoxetine involving data on 840 patients, the researchers tested the number of weeks treatment should continue with no improvement before it was changed. A blinded, placebo-controlled discontinuation study followed the trial treatment of 20 mg a day fluoxetine.
Based on Hamilton Depression Rating Scale scores, outcomes were classified as non-response, partial response, response and remission at 4, 6, 8, 10 and 12 weeks. At week 12 the rate of remission was calculated for each group of subjects with no remission at the previous time points.
In the discontinuation study, the time to relapse during weeks 13 to 26 was checked in those taking placebo and fluoxetine in relation to status at week 6. A remission rate of 31 to 41% was found in subjects who were unimproved at week 6.
The level of improvement at week 6 was seen not to affect prognosis in weeks 13 to 26 in patients with remission at week 12. For those who were unimproved at week 8, 23% were found to have remissions by week 12.
Continued treatment was clearly justified for those subjects who were unimproved at week 4 by the high remission rate in week 12.
For unimproved patients at week 10, however, the rate was too low.
Am J Psychiatry 2003 Apr;160:4:734-40.
"When should a trial of fluoxetine for major depression be declared failed?"
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