Short-term cotherapy with clonazepam and fluoxetine: anxiety, sleep disturbance and core symptoms of depression.
BACKGROUND
SSRIs resolve depression slowly and may increase anxiety or insomnia. Adding clonazepam to fluoxetine sped response, raising the question of mechanism of action: reducing symptoms co-existing with depression, suppressing side-effects, and/or alleviating core depressive symptoms.


METHODS
Adult outpatients randomly assigned to double-blind treatment with fluoxetine 20 mg+placebo or fluoxetine+clonazepam 0.5-1.0 mg were assessed by a HAM-D anxiety cluster, sleep disturbance cluster, and core symptoms cluster.


RESULTS
No serious AEs were noted; no cotherapy patients dropped for AEs. Cotherapy proved superior (HAM-D total, anxiety cluster, sleep disturbance cluster ANOVA P<0.001; core symptoms P<0.011). Treatment-emergent anxiety was reported for 25% of placebo patients and 7% of cotherapy patients (P<0.037); sleep disturbance for 10% of placebo patients and no cotherapy patients (P<0.055). Sedation and dry mouth were more common for cotherapy treatment (P>0.20).


CONCLUSIONS
Extended treatment and refractory depression were not addressed.


CONCLUSIONS
Low-dose cotherapy of fluoxetine with clonazepam was safe and accelerated response over 21 days of treatment, decreasing anxiety and sleep disturbance as symptoms and partially suppressed them as SSRI side-effects; it also modestly reduced core symptoms of low mood and loss of interest.
Londborg
P D
PD
Summit Research Network, 1849 NW Kearney, Suite 201, 97209, Portland, OR, USA.
Smith
W T
WT
Glaudin
V
V
Painter
J R
JR
D000328:Adult; D000368:Aged; D001007:Anxiety / Q000175:diagnosis / Q000188:drug therapy*; D002998:Clonazepam / Q000008:administration & dosage / Q000627:therapeutic use*; D003865:Major Depressive Disorder / Q000175:diagnosis / Q000188:drug therapy*; D004305:Dose-Response Relationship, Drug; D004359:Drug Therapy, Combination; D005260:Female; D005473:Fluoxetine / Q000008:administration & dosage / Q000009:adverse effects / Q000627:therapeutic use*; D018757:GABA Modulators / Q000008:administration & dosage / Q000627:therapeutic use*; D006801:Humans; D008297:Male; D008875:Middle Aged; D017367:Selective Serotonin Reuptake Inhibitors / Q000008:administration & dosage / Q000009:adverse effects / Q000627:therapeutic use*; D012893:Sleep Wake Disorders / Q000175:diagnosis / Q000188:drug therapy*; D013997:Time Factors; D016896:Treatment Outcome
D002998:Clonazepam; D005473:Fluoxetine; D018757:GABA Modulators; D017367:Selective Serotonin Reuptake Inhibitors