Sertraline versus imipramine to prevent relapse in chronic depression.
BACKGROUND
Chronic depressions are common, disabling and under-treated, and long-term treatment is little studied. We report the continuation phase results from a long-term treatment study.


METHODS
After 12 weeks of acute phase treatment in a double-blind, randomized, parallel-group, multi-center trial of sertraline or imipramine, patients with chronic depression (> or = 2 years in major depression, or major depression superimposed on dysthymia) continued study drug for 16 weeks. Initially, 635 patients were randomized to sertraline or imipramine in a 2:1 ratio. Nonresponders after 12 weeks entered a 12-week double-blind crossover trial of the alternate medication. Entry into continuation treatment required at least a satisfactory response (partial remission) to initial or crossover treatment.


RESULTS
Of 239 acute or crossover responders to sertraline, 60% entered continuation in full remission and 40% with a partial remission. These proportions were identical for imipramine patients (n = 147). For both drug groups, over two-thirds of those entering in full remission retained it. For those entering in partial remission, over 40% achieved full remission. Patients requiring crossover treatment were less likely to maintain or improve their response during continuation treatment. The two drugs did not differ significantly in response distribution, drop out rates or discontinuation due to side effects during continuation treatment.


CONCLUSIONS
The absence of a placebo group constrains interpretation of our results, but chronic depressions have low placebo response rates.


CONCLUSIONS
Most chronic depression patients who remit with 12 weeks of sertraline or imipramine treatment maintain remission during 16 weeks of continuation treatment. Most patients with a satisfactory therapeutic response (partial remission) after 12 weeks of treatment maintain it or further improve. Patients treated with imipramine experienced more side effects, but both drugs were well tolerated.
Koran
L M
LM
Stanford University Medical Center, CA, USA. lkoran@stanford.edu
Gelenberg
A J
AJ
Kornstein
S G
SG
Howland
R H
RH
Friedman
R A
RA
DeBattista
C
C
Klein
D
D
Kocsis
J H
JH
Schatzberg
A F
AF
Thase
M E
ME
Rush
A J
AJ
Hirschfeld
R M
RM
LaVange
L M
LM
Keller
M B
MB
D000328:Adult; D000368:Aged; D002908:Chronic Disease; D018592:Cross-Over Studies; D003865:Major Depressive Disorder / Q000175:diagnosis / Q000188:drug therapy* / Q000523:psychology; D004311:Double-Blind Method; D019263:Dysthymic Disorder / Q000175:diagnosis / Q000188:drug therapy* / Q000523:psychology; D005260:Female; D006801:Humans; D007099:Imipramine / Q000009:adverse effects / Q000627:therapeutic use*; D008297:Male; D008875:Middle Aged; D011569:Psychiatric Status Rating Scales; D012008:Recurrence; D020280:Sertraline / Q000009:adverse effects / Q000627:therapeutic use*
D007099:Imipramine; D020280:Sertraline