Fluoxetine treatment for depression in patients with HIV and AIDS: a randomized, placebo-controlled trial.
OBJECTIVE
The goals of this study were to determine whether fluoxetine is superior to placebo in treating HIV-seropositive patients with major depression or dysthymia or both, whether severity of immunosuppression is associated with treatment response, and whether fluoxetine treatment is associated with change in immune status as measured by CD4 cell count.


METHODS
A double-blind, randomized, placebo-controlled 8-week trial of fluoxetine was conducted in a university-affiliated research outpatient clinic. The fluoxetine-placebo randomization was 2:1. All patients were offered 4 months of additional open treatment. Main outcome measures included the Clinical Global Impression, Hamilton Depression Rating Scale, and CD4 cell count.


RESULTS
Of 120 patients randomly assigned to fluoxetine or placebo, 87 completed 8 weeks of treatment. In the total group, 51% had AIDS. All but three were men, 35% were nonwhite, and 6% had intravenous drug use as a risk factor. In an intention-to-treat analysis, 57% of fluoxetine patients and 41% of placebo patients were responders. Among patients who completed the study, 74% responded to fluoxetine and 47% to placebo; this difference was statistically significant. Severity of immunosuppression was not related to antidepressant response, attrition, or side effects, and fluoxetine treatment was not associated with change in CD4 cell count.


CONCLUSIONS
Fluoxetine is an effective antidepressant in the context of HIV illness. However, both placebo response and attrition were substantial, suggesting both that nonspecific factors may be more salient and that yet another medication (i.e., an antidepressant) may be less acceptable among patients with serious medical illness already requiring multiple concomitant medications.
Rabkin
J G
JG
New York State Psychiatric Institute and Department of Psychiatry, College of Physicians and Surgeons, Columbia University, New York 10032, USA. jgrl@columbia.edu
Wagner
G J
GJ
Rabkin
R
R
D000163:Acquired Immunodeficiency Syndrome / Q000150:complications* / Q000276:immunology / Q000523:psychology; D000328:Adult; D018791:CD4 Lymphocyte Count / Q000187:drug effects; D003866:Depressive Disorder / Q000188:drug therapy* / Q000209:etiology; D004311:Double-Blind Method; D005163:Factor Analysis, Statistical; D005260:Female; D005473:Fluoxetine / Q000627:therapeutic use*; D006679:HIV Seropositivity / Q000150:complications* / Q000276:immunology / Q000523:psychology; D006801:Humans; D007108:Immune Tolerance / Q000187:drug effects; D008297:Male; D008875:Middle Aged; D010352:Patient Dropouts; D010919:Placebos; D011569:Psychiatric Status Rating Scales / Q000706:statistics & numerical data; D012720:Severity of Illness Index; D016896:Treatment Outcome
D010919:Placebos; D005473:Fluoxetine