Treatment strategy in depression. I. Non-tricyclic and selective reuptake inhibitors in resistant depression: a double-blind partial crossover study on the effects of oxaprotiline and fluvoxamine.
Antidepressants are ineffective in about 30% of patients with major depression. Some authors then advise treatment of non-responders with (non-tricyclic) more selective reuptake inhibitors. In a double-blind, partial crossover study, 71 patients were selected for treatment during 4 weeks with oxaprotiline and/or fluvoxamine, two non-tricyclic antidepressants that are selective reuptake inhibitors or noradrenaline and serotonin respectively. All patients had failed to respond to earlier treatment with cyclic antidepressants during the current episode. Only 13% of the patients responded, with 27% of them responding to oxaprotiline and none to fluvoxamine. Moreover, a low response of 27% was also obtained in the crossover phase, which included all non-responders to the first treatment, oxaprotiline being effective in 39% and fluvoxamine in 10% of the patients. The results indicate that selective reuptake inhibitors are not an effective alternative for non-responders to other cyclic antidepressants and that non-responders to "noradrenergic" antidepressants do not appear to have much chance of responding to "serotonergic" antidepressants and vice versa.
Nolen
W A
WA
Department of Biological Psychiatry, Psychiatric Centre Bloemendaal, Hague, the Netherlands.
van de Putte
J J
JJ
Dijken
W A
WA
Kamp
J S
JS
Blansjaar
B A
BA
Kramer
H J
HJ
Haffmans
J
J
D000328:Adult; D000873:Anthracenes / Q000627:therapeutic use*; D001714:Bipolar Disorder / Q000188:drug therapy* / Q000523:psychology; D003866:Depressive Disorder / Q000188:drug therapy* / Q000523:psychology; D004311:Double-Blind Method; D005260:Female; D016666:Fluvoxamine; D006801:Humans; D008297:Male; D008376:Maprotiline / Q000031:analogs & derivatives / Q000627:therapeutic use*; D008875:Middle Aged; D010091:Oximes / Q000627:therapeutic use*; D010554:Personality Disorders / Q000188:drug therapy; D011581:Psychological Tests; D011594:Psychometrics
D000873:Anthracenes; D010091:Oximes; D008376:Maprotiline; C027299:hydroxymaprotilin; D016666:Fluvoxamine