Loss of Antidepressant Efficacy During Maintenance Therapy

Byrne, Sarah; Rothschild, Anthony J.

doi:10.4088/jcp.v59n0602

Cited by 128 publications

(85 citation statements)

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“…An enigma associated with virtually all antidepressants is inexplicable relapse during continuation or maintenance treatment (Byrne and Rothschild, 1998;Nierenberg and Alpert, 2000), a phenomenon referred to as tachyphylaxis. This is not an insignificant problem since recurrence rates vary from 15 to 40% in long-term clinical trials, a proportion mirrored in clinical practice (Coppen et al, 1978;Prien et al, 1973Prien et al, , 1984Montgomery et al, 1988;Rouillon et al, 1989;Frank et al, 1990;Doogan and Caillard, 1992;Kupfer et al, 1992;Montgomery and Dunbar, 1993).…”

Section: Introductionmentioning

confidence: 99%

“…In addition to poor medication compliance, other possible causes of depressive breakthrough include tolerance and loss of acute placebo effect (Byrne and Rothschild, 1998;Nierenberg and Alpert, 2000). Pharmacodynamic and pharmacokinetic effects, changes in disease severity and depletion of a relevant effector substance have also been considered possible causes of tolerance (Mann, 1983;Lieb and Balter, 1984;Cohen and Baldessarini, 1985;Donaldson, 1989).…”

Section: Introductionmentioning

confidence: 99%

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Placebo-Controlled Continuation Treatment with Mirtazapine: Acute Pattern of Response Predicts Relapse

Nierenberg

Quitkin

Kremer³

et al. 2004

Neuropsychopharmacol

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Pattern of response to antidepressants has been proposed as a method to identify patients whose improvement is more likely due to drug vs those whose improvement on drug is more likely to be a placebo effect. It is hypothesized that those with 'true-drug initial response pattern' are most likely to benefit from continuation treatment. The relationship between acute patterns of response and subsequent placebo-controlled continuation treatment with the antidepressant mirtazapine is examined. A total of 410 outpatients were treated openly with mirtazapine for 8-12 weeks. Patients who remitted in the acute phase were randomized to continue the same dose of mirtazapine or switched to placebo. Acute phase responders were classified as 'placebo initial response pattern' (early responders and nonpersistent responders) and 'true-drug initial response pattern' (delayed and persistent responders). Of those with a 'true-drug initial response pattern,' 10/40 (25.0%) relapsed with continuation mirtazapine, and 23/41 (56.1%) relapsed when switched to placebo. The difference (31.1%) is significant. Of those with a 'placebo initial response pattern,' 5/36 (13.9%) relapsed with continuation mirtazapine, and 12/39 (30.8%) relapsed with placebo substitution. This difference (16.9%) is not statistically significant. Moreover, the relapse rate for 'true-drug initial response pattern' patients switched to placebo (56.1%) was also significantly greater than for 'placebo initial response pattern' patients switched to placebo (30.8%). It has been suggested that patients with late onset and persistence are more likely to have improved because of drug. This hypothesis gains support from this study because of the different relapse rates of 'true-drug' responders on drug and placebo. The low relapse rate for patients with an acute placebo pattern switched to placebo suggests specific drug effect played a smaller role in their initial improvement.

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Section: Introductionmentioning

confidence: 99%

Section: Introductionmentioning

confidence: 99%

Placebo-Controlled Continuation Treatment with Mirtazapine: Acute Pattern of Response Predicts Relapse

Nierenberg

Quitkin

Kremer³

et al. 2004

Neuropsychopharmacol

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“…Of the patients who recover from a depressive episode, more than 50% relapse (Kennedy et al, 2004). The return of depressive symptoms during maintenance therapy with antidepressants occurs at rates that vary from 9 to 57% (Byrne & Rothschild, 1998).…”

Section: Epidemiological Aspectsmentioning

confidence: 99%

“…Structured sessions also help patients develop a sense of personal control and enhance the efficiency of treatment. Patients with personality disorders may require more time in therapy, even more than 12 months (Byrne & Rothschild, 1998). Often, these patients tend to drop out from treatment more easily and the therapist should be attuned to the therapeutic alliance.…”

Section: The Duration Of Treatment and Remission Of Symptomsmentioning

confidence: 99%

Cognitive Behavioral Therapy for Depression

Sudak¹

2012

Psychiatric Clinics of North America

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“…Whitaker's (2010) book Anatomy of an Epidemic contrasts pre-drug outcomes with currently reported outcomes. Whitaker and others have speculated that antidepressants might worsen the course of depression and contribute to chronicity (Byrne & Rothchild, 1998;Fava & Offandini, 2011).…”

Section: What To Conclude About Prevention Of Relapse?mentioning

confidence: 99%