Slow versus standard up-titration of paroxetine for the treatment of depression in cancer patients: a pilot study

Abstract

The results of this study suggest that slow paroxetine up-titration is better tolerated and at least as effective as the standard paroxetine up-titration in cancer patients with depression.

Pharmacological management of unipolar depression

“…Commencing a patient on antidepressant levels at, or less than, the recommended dose with the intention to titrate treatment is particularly useful for patients who are frail (e.g. elderly, those with comorbid medical illness) or when commencing certain classes of antidepressants. For example, tricyclic antidepressants need to be titrated because of potential cardiac toxicity associated with peak plasma levels .…”

“…For example, tricyclic antidepressants need to be titrated because of potential cardiac toxicity associated with peak plasma levels . Additionally, in practice, patients on SSRIs and SNRIs can decrease their risk of transitory side‐effects by commencing treatment on low doses and titrating the dose slowly to reach therapeutic levels .…”

Benefit of slow titration of paroxetine to treat depression in the elderly

“…(), for example, there was a small superiority of slow up‐titration regimen of paroxetine compared with the standard one in the first 9 days of treatment (Buoli et al ., ). More recently, slow and standard paroxetine titration was shown to be approximately equally effective in cancer patients with depression, yet slow titration was better tolerated (Amodeo et al ., ). In our original sample, previously reported (Gibiino et al ., ), of individuals over 60 years of age who suffered from MDD, remission rate was 80% using slow titration scheme, that is, twice higher than that reported for standard titration.…”

“…Recently, a slow titration scheme was applied to paroxetine treatment. It showed modest but consistent benefits in panic disorder (Buoli et al ., ) and for the treatment of depression in cancer patients (Amodeo et al ., ). We tested this approach in geriatric (<60 years) depression.…”

Persistent benefits of slow titration of paroxetine in a six‐month follow‐up

“…However, if paroxetine is gradually titrated and therapeutic dose reached slowly, there might be less accumulation, with advantages in terms of tolerability. For example, in a study of depressed patients with cancer, slow titration of paroxetine was as effective as standard titration but associated with less frequent and severe side effects and fewer dropouts (Amodeo et al, 2012). Titration scheme also seems to affect paroxetine efficacy.…”