Retreatment for relapse following desipramine discontinuation in dysthymia

Ra, Friedman; Mitchell, Jeff; Jh, Kocsis

doi:10.1176/ajp.152.6.926

Cited by 13 publications

(5 citation statements)

References 6 publications

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“…Two studies with other antidepressants have also reported high rates of response to retreatment with the same antidepressant in patients having a diagnosis of either depression or dysthymia [9, 15]. A retrospective chart review by Remillard et al [15]reported a 69.5% rate of response to retreatment with the same antidepressant that had been successfully prescribed in a previous episode among patients diagnosed with recurrent major depression.…”

Section: Discussionmentioning

confidence: 99%

“…That study, however, did not utilize standardized diagnostic assessments or standardized outcome measures. In the first and only prospective study to examine response to reinitiation of treatment, Friedman et al [9]found that 91.7% of 12 patients diagnosed with pure dysthymia or double depression (i.e., dysthymia and major depression) achieved full remission after receiving open treatment with desipramine at a dose equal or greater than the continuation phase desipramine dose to which they had originally responded to.…”

Section: Discussionmentioning

confidence: 99%

“…Friedman et al [9]conducted the first and only pilot, prospective study in the literature on 12 patients who had relapsed after being switched to placebo as part of a double-blind maintenance treatment study with desipramine. These 12 patients received open treatment with desipramine at a dose equal or greater than the continuation phase desipramine dose they had originally responded to.…”

Section: Introductionmentioning

confidence: 99%

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Treatment Approaches to Major Depressive Disorder Relapse

Fava

Schmidt

Zhang

et al. 2002

Psychother Psychosom

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Background: Anecdotal reports concerning mood disorder patients suggest restarting drug treatment in patients who prematurely discontinue it may be associated with a diminished chance of response upon rechallenge. We evaluated the likelihood of response to reinitiation of fluoxetine treatment in patients relapsing after switching to placebo during a long-term efficacy study of two different dosing regimens of fluoxetine. Method: Patients who met the DSM-IV major depressive disorder criteria with modified HAMD17 scores ≧18 and CGI-Severity scores ≧4 were treated with open-label 20 mg/day fluoxetine for 13 weeks in a multicenter US study. Responders (n = 501) were randomized to placebo, 20 mg fluoxetine daily, or 90 mg enteric-coated fluoxetine weekly for 25 weeks of double-blind continuation treatment. Patients relapsing during the continuation phase were offered 25 weeks of double-blind rescue treatment during which the study medication dose was increased as follows: (1) patients on placebo had treatment with fluoxetine 20 mg/ day reinitiated; (2) patients on fluoxetine 20 mg/day had their dose increased to 40 mg/day, and (3) patients on a 90-mg weekly dose had their dose increased to 90 mg twice a week. Only the results of the rescue phase for the group who relapsed while on continuation treatment with placebo are reported here. Analyses included percentage of responders (50% reduction of modified HAMD17 and CGI-Severity ≤2) and assessments of change from baseline to endpoint (HAMD, CGI-Severity). Safety measures included assessment of vital signs, laboratory measures, and treatment-emergent adverse events. Results: Of 122 patients assigned to placebo, 57 (47%) relapsed during continuation treatment. Fifty-five (96%) of these elected to enter double-blind rescue treatment. Overall, patients who relapsed upon switching to placebo responded well to reinitiation of fluoxetine (62%). The mean modified HAMD17 score decreased from 20 to less than 9 and was maintained for up to 6 months. Thirty-eight percent of patients either did not respond or initially responded but again relapsed after reinitiation of medication. Conclusion: This study suggests that patients who, after an initial response to fluoxetine, relapse upon switching to placebo have a relatively high probability of responding to the reinitiation of fluoxetine treatment. These results challenge the view that the efficacy of an agent prematurely discontinued is diminished when such an agent is restarted. They also generally support reinitiation of the same antidepressant as a ‘first-line’ treatment strategy in patients who relapsed after stopping a previously effective antidepressant.

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Section: Discussionmentioning

confidence: 99%

Section: Discussionmentioning

confidence: 99%

Section: Introductionmentioning

confidence: 99%

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Treatment Approaches to Major Depressive Disorder Relapse

Fava

Schmidt

Zhang

et al. 2002

Psychother Psychosom

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“…Evidence of long-term effectiveness and safety for antidepressant treatment in bipolar disorders is lacking [2, 6]. There is also growing evidence that a loss of benefit can emerge with long-term antidepressant treatment or on retreatment after discontinuation [7, 8, 9, 10], perhaps even more commonly among bipolar than unipolar depressed patients [11]. …”

Section: Introductionmentioning

confidence: 99%

“…However, sampling may be biased by including all eligible subjects initially, but retreating only initially fluoxetine-responsive patients. Relative risk of unresponsiveness to retreatment with other antidepressants remains inadequately studied [7, 8, 9, 10, 11], but preliminary findings suggest variance among specific agents [11]. Similarly, responses to retreatment after failing lithium among bipolar disorder patients have been inconsistent [16, 17].…”

Section: Introductionmentioning

confidence: 99%