Will a second prophylactic treatment with a higher dosage of the same antidepressant either prevent or delay new depressive episodes?
Fifty-seven highly recurrent unipolar patients, excluded from previous long-term studies with selective serotonin reuptake inhibitors (SSRIs) after they experienced a new recurrence, were acutely treated with the full dosage of the SSRIs they were on. Fifty-one of them (89.5%) had a sustained response and entered into the 4-month continuation therapy. During this phase, no relapse was observed. At the end of it, all patients gave their written informed consent to be enrolled in a 24-month long-term therapy, maintaining the same treatment dosage of fluvoxamine 300 mg/day, sertraline 150 mg/day, or paroxetine 40 mg/day. At the end of the study, 28 out of the 51 outpatients (54.9%) showed a further recurrence. Nevertheless, second recurrences observed during this second maintenance therapy were less severe than first recurrences, decreasing from 25.1+/-3.4 to 21.6+/-3.3 (P<0.0001), respectively. Considering the clinical characteristics of patients, we found that a high number of prior depressive episodes and an early age at onset of illness may predict a bad outcome. Moreover, patients with a longer duration of euthymia during a first maintenance period are less likely to have a new episode of depression.
Franchini
L
L
Istituto Scientifico H. San Raffaele, Department of Neuropsychiatric Sciences, School of Medicine, University of Milan, Via Luigi Prinetti, 29, 20127, Milan, Italy. franchini.linda@hsr.it
Rossini
D
D
Bongiorno
F
F
Spagnolo
C
C
Smeraldi
E
E
Zanardi
R
R
D000328:Adult; D003866:Depressive Disorder / Q000188:drug therapy* / Q000517:prevention & control*; D004305:Dose-Response Relationship, Drug; D005260:Female; D016666:Fluvoxamine / Q000008:administration & dosage; D006801:Humans; D008297:Male; D008875:Middle Aged; D017374:Paroxetine / Q000008:administration & dosage; D016016:Proportional Hazards Models; D012307:Risk Factors; D055502:Secondary Prevention; D017367:Selective Serotonin Reuptake Inhibitors / Q000008:administration & dosage*; D020280:Sertraline / Q000008:administration & dosage; D012720:Severity of Illness Index; D016896:Treatment Outcome
D016666:Fluvoxamine; D017374:Paroxetine; D017367:Selective Serotonin Reuptake Inhibitors; D020280:Sertraline