Effects of adjunctive reboxetine in patients with duloxetine-resistant depression: a 12-week prospective study

Seguí, J; López-Muñoz, Francisco; Álamo, Cecilio; Camarasa, Xavier; García-García, Pilar; Pardo, Antonio

doi:10.1177/0269881109102641

Cited by 10 publications

(6 citation statements)

References 69 publications

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“…After 8 weeks of add-on treatment to paroxetine, remission was achieved by 32.6% of the patients with buspirone and 42.6% with trazodone [ 25 ]; the difference between the groups was not significant. Reboxetine add-on to duloxetine in MDD patients who did not respond to an 8-week duloxetine trial was evaluated in an open-label study; 76% of the patients on reboxetine augmentation for 12 weeks responded and 69.3% remitted [ 26 ].…”

Section: Combining Antidepressantsmentioning

confidence: 99%

Challenging Treatment-Resistant Major Depressive Disorder: A Roadmap for Improved Therapeutics

Sousa¹,

Zanetti²,

Brunoni³

et al. 2015

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Major depressive disorder (MDD) is associated with a significant burden and costs to the society. As remission of depressive symptoms is achieved in only one-third of the MDD patients after the first antidepressant trial, unsuccessful treatments contribute largely to the observed suffering and social costs of MDD. The present article provides a summary of the therapeutic strategies that have been tested for treatment-resistant depression (TRD). A computerized search on MedLine/PubMed database from 1975 to September 2014 was performed, using the keywords "treatment-resistant depression", "major depressive disorder", "adjunctive", "refractory" and "augmentation". From the 581 articles retrieved, two authors selected 79 papers. A manual searching further considered relevant articles of the reference lists. The evidence found supports adding or switching to another antidepressant from a different class is an effective strategy in more severe MDD after failure to an initial antidepressant trial. Also, in subjects resistant to two or more classes of antidepressants, some augmentation strategies and antidepressant combinations should be considered, although the overall response and remission rates are relatively low, except for fast acting glutamatergic modulators. The wide range of available treatments for TRD reflects the complexity of MDD, which does not underlie diverse key features of the disorder. Larger and well-designed studies applying dimensional approaches to measure efficacy and effectiveness are warranted.

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Section: Combining Antidepressantsmentioning

confidence: 99%

Challenging Treatment-Resistant Major Depressive Disorder: A Roadmap for Improved Therapeutics

Sousa¹,

Zanetti²,

Brunoni³

et al. 2015

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“…A decrease of 50% or more of the total score of the main symptom rating scale (BPD-SI in our study) was considered a criterion of response in several recent trials. [52][53][54] The Dosage Record Treatment Emergent Symptom Scale 46 was used to collect adverse effects.…”

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confidence: 99%

Adaptation of Interpersonal Psychotherapy to Borderline Personality Disorder: A Comparison of Combined Therapy and Single Pharmacotherapy

2010

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W La Revue canadienne de psychiatrie, vol 55, no 2, février 2010 74Objective: Combined treatment with interpersonal psychotherapy (IPT) and antidepressants (ADs) has been found more effective than single pharmacotherapy in patients with major depression and concomitant borderline personality disorder (BPD). The aim of our study is to investigate whether combined treatment with a modified version of IPT is still superior to ADs when treating patients with a single diagnosis of BPD.Method: Fifty-five consecutive outpatients with a Diagnostic and Statistical Manual of Mental Disorders, Fourth Edition, Text Revision, diagnosis of BPD were enrolled. They were randomly assigned to 2 treatment arms for 32 weeks: fluoxetine 20 to 40 mg per day plus clinical management; and fluoxetine 20 to 40 mg per day plus IPT adapted to BPD (IPT-BPD). Eleven patients (20%) discontinued treatment owing to noncompliance. Forty-four patients completed the treatment period. They were assessed at baseline, and at week 16 and 32 with: a semi-structured interview for demographic and clinical variables; Clinical Global Impression Scale (CGI-S); Hamilton Depression Rating Scale (HDRS); Hamilton Anxiety Rating Scale (HARS); Social and Occupational Functioning Assessment Scale (SOFAS); BPD Severity Index (BPD-SI); and a questionnaire for quality of life (Satisfaction Profile [SAT-P]). A univariate general linear model was performed with 2 factors: duration and type of treatment. P values of less than 0.05 were considered significant. Results:Remission rates did not differ significantly between subgroups. Duration, but not type of treatment, had a significant effect on CGI-S, HDRS, SOFAS, and total BPD-SI score changes. Combined therapy was more effective on the HARS; the items: interpersonal relationships, affective instability, and impulsivity of BPD-SI; and the factors: psychological functioning and social functioning of SAT-P. Conclusions:Combined therapy with adapted IPT was superior to fluoxetine alone in BPD patients, concerning a few core symptoms of the disorder, anxiety, and quality of life.Can J Psychiatry. 2010;55(2):74-81. Clinical Implications· IPT adapted to BPD can be an efficacious model of intervention that responds to the growing demand for manualized and time-limited treatment of BPD patients. · Pharmacotherapy (selective serotonin reuptake inhibitors) and combined treatment with IPT-BPD are both efficacious in treating BPD patients without Axis I comorbidity. · Combined treatment with IPT-BPD is more efficacious than single pharmacotherapy on a few core symptoms of BPD, anxiety symptoms, and subjective quality of life. Limitations· Owing to the exclusion of patients with Axis I comorbidity, clinical characteristics of our BPD patients can be different from clinical practice. · Assessment scales did not include an assessment instrument designed to investigate the specific mechanisms of action of IPT on BPD psychopathology. · This initial trial of IPT-BPD did not include intention-to-treat analyses.

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“…[180] These limited investigations reported response rates from 26.1% to 34.6% for bupropion and from 45.3% to 76% for reboxetine. Dropout rates due to treatmentemergent adverse events were between 10% and 27%.…”

Section: Tcas and Mianserinmentioning

confidence: 96%

Therapeutic Options for Treatment-Resistant Depression

Shelton

Osuntokun

Heinloth³

et al. 2010

CNS Drugs

186

137

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Treatment-resistant depression (TRD) presents major challenges for both patients and clinicians. There is no universally accepted definition of TRD, but results from the US National Institute of Mental Health's (NIMH) STAR*D (Sequenced Treatment Alternatives to Relieve Depression) programme indicate that after the failure of two treatment trials, the chances of remission decrease significantly. Several pharmacological and nonpharmacological treatments for TRD may be considered when optimized (adequate dose and duration) therapy has not produced a successful outcome and a patient is classified as resistant to treatment. Nonpharmacological strategies include psychotherapy (often in conjunction with pharmacotherapy), electroconvulsive therapy and vagus nerve stimulation. The US FDA recently approved vagus nerve stimulation as adjunctive therapy (after four prior treatment failures); however, its benefits are seen only after prolonged (up to 1 year) use. Other nonpharmacological options, such as repetitive transcranial stimulation, deep brain stimulation or psychosurgery, remain experimental and are not widely available. Pharmacological treatments of TRD can be grouped in two main categories: 'switching' or 'combining'. In the first, treatment is switched within and between classes of compounds. The benefits of switching include avoidance of polypharmacy, a narrower range of treatment-emergent adverse events and lower costs. An inherent disadvantage of any switching strategy is that partial treatment responses resulting from the initial treatment might be lost by its discontinuation in favour of another medication trial. Monotherapy switches have also been shown to have limited effectiveness in achieving remission. The advantage of combination strategies is the potential to build upon achieved improvements; they are generally recommended if partial response was achieved with the current treatment trial. Various non-antidepressant augmenting agents, such as lithium and thyroid hormones, are well studied, although not commonly used. There is also evidence of efficacy and increasing use of atypical antipsychotics in combination with antidepressants, for example, olanzapine in combination with fluoxetine (OFC) or augmentation with aripiprazole. The disadvantages of a combination strategy include multiple medications, a broader range of treatment-emergent adverse events and higher costs. Several experimental pharmaceutical treatment alternatives for TRD are also being explored in combination with antidepressants or as monotherapy. These less studied alternative compounds include pindolol, inositol, CNS stimulants, hormones, herbal supplements, omega-3 fatty acids, S-adenosyl-L-methionine, folic acid, lamotrigine, modafinil, riluzole and topiramate. In summary, despite an increasing variety of choices for the treatment of TRD, this condition remains universally undefined and represents an area of unmet medical need. There are few known approved pharmacological agents for TRD (aripiprazole and OFC) and overall outcomes rema...

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Effects of adjunctive reboxetine in patients with duloxetine-resistant depression: a 12-week prospective study

Cited by 10 publications

References 69 publications

Challenging Treatment-Resistant Major Depressive Disorder: A Roadmap for Improved Therapeutics

Challenging Treatment-Resistant Major Depressive Disorder: A Roadmap for Improved Therapeutics

Adaptation of Interpersonal Psychotherapy to Borderline Personality Disorder: A Comparison of Combined Therapy and Single Pharmacotherapy

Therapeutic Options for Treatment-Resistant Depression

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