Tolerance to therapeutic effects of antidepressants

Bm, Cohen; Rj, Baldessarini

doi:10.1176/ajp.142.4.489

Cited by 43 publications

(5 citation statements)

References 4 publications

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“…A number of explanations have been forwarded to account for the apparent loss of efficacy of antidepressants over time including noncompliance, loss of placebo effect, tolerance, and change in the underlying disease pathogenesis [7, 15, 16, 17]. Of these, the development of tolerance through changes in steady-state pharmacokinetics (e.g.…”

Section: Discussionmentioning

confidence: 99%

Treatment Approaches to Major Depressive Disorder Relapse

Schmidt

Fava

Zhang

et al. 2002

Psychother Psychosom

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Objective: Although continuing antidepressant treatment after patients have responded to medication has been shown to greatly reduce the risk of relapse, this risk is not eliminated. A number of theories have been proposed to account for this apparent loss of efficacy. A common initial approach to managing relapse is to increase the dose of antidepressant. We prospectively evaluated the likelihood of response to increasing the fluoxetine doses in patients relapsing during a long-term efficacy study of two fluoxetine dosing regimens. Method: Patients meeting the DSM-IV criteria for major depressive disorder with modified HAMD17 scores ≧18 and CGI-severity scores ≧4 were treated for 13 weeks with open-label 20 mg/day fluoxetine in a multicenter US study. Responders (n = 501) were randomized to 20 mg fluoxetine daily, placebo, or 90 mg enteric-coated fluoxetine weekly for 25 weeks of double-blind continuation treatment. If the patients relapsed during the continuation phase, they were offered a 25-week optional rescue treatment phase 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. The results of the rescue phase for the latter two groups who relapsed while on continuation treatment with fluoxetine are reported. Response was defined as a 50% reduction in the modified HAMD17 score since time of relapse and a CGI-severity score ≤2. Additional efficacy analyses included HAMD and CGI-severity changes from baseline to endpoint. Safety measures included assessment of treatment-emergent adverse events, vital signs, and laboratory measures. Results: Overall, patients relapsing during the continuation treatment responded to an increased dose (57% of the 40-mg-daily group and 72% of the enteric-coated 90-mg-twice-weekly group). Mean modified HAMD17 scores decreased from a mean of approximately 20 to below 8 and were maintained for up to 6 months in the responders. Thirty-five percent of patients either did not respond or initially responded but again relapsed after augmentation of medication. Conclusions: The patients relapsing after initially responding to fluoxetine can benefit from an increase in fluoxetine dose. These results also generally support increasing dose as a first-line treatment strategy for a patient who has relapsed while taking a previously effective dose of an antidepressant. Increasing enteric-coated fluoxetine 90 mg once weekly to twice weekly appeared to be as well-tolerated and effective in restoring response as increasing a daily fluoxetine dose from 20 to 40 mg.

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Section: Discussionmentioning

confidence: 99%

Treatment Approaches to Major Depressive Disorder Relapse

Schmidt

Fava

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%

Tolerance in Antidepressant Treatment

Baldessarini

Ghaemi

Viguera

2002

Psychother Psychosom

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“…In fact, depression and anxiety symptoms in humans tend to increase in parallel with GI symptom severity and frequency (Pinto-Sanchez et al, 2015), making this comorbidity even more relevant. Current treatment methods, however, involve administering a selective serotonin-reuptake inhibitor that, although effective in ameliorating behavioral symptoms, can have negative effects from long-term use and does not address the root cause of the issue (Cohen & Baldessarini, 1985). Alternatively, administering beneficial bacteria that are known to increase serotonin levels (Neufeld et al, 2011; Reigstad et al, 2015) in the form of a probiotic or by following a diet that supports bacteria critical for serotonin production may effectively influence mood as well as concomitant GI symptoms.…”

Section: Neuroscience and The Gut–brain Axismentioning

confidence: 99%

Microbes and the Mind: How Bacteria Shape Affect, Neurological Processes, Cognition, Social Relationships, Development, and Pathology

Smith

Wissel

2019

Perspect Psychol Sci

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Recent data suggest that the human body is not so exclusively human after all. Specifically, humans share their bodies with approximately 10 trillion microorganisms, collectively known as the microbiome. Chief among these microbes are bacteria, and there is a growing consensus that they are critical to virtually all facets of normative functioning. This article reviews the ways in which bacteria shape affect, neurological processes, cognition, social relationships, development, and psychological pathology. To date, the vast majority of research on interactions between microbes and humans has been conducted by scientists outside the field of psychology, despite the fact that psychological scientists are experts in many of the topics being explored. This review aims to orient psychological scientists to the most relevant research and perspectives regarding the microbiome so that we might contribute to the now widespread, interdisciplinary effort to understand the relationship between microbes and the mind.

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Tolerance to therapeutic effects of antidepressants

Cited by 43 publications

References 4 publications

Treatment Approaches to Major Depressive Disorder Relapse

Treatment Approaches to Major Depressive Disorder Relapse

Tolerance in Antidepressant Treatment

Microbes and the Mind: How Bacteria Shape Affect, Neurological Processes, Cognition, Social Relationships, Development, and Pathology

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