title: A pilot, open study of sertraline in outpatients with treatment-resistant depression (TRD) or with a history of TRD who responded but later relapsed.
abstract: While most depressed patients are prescribed a selective serotonin reuptake inhibitor (SSRI) as an initial treatment, the use of SSRIs as a second or third-line treatment for depression is not as prevalent. This trial assessed the efficacy of sertraline for patients with treatment-resistant depression (TRD) or patients with a history of TRD who responded but later relapsed. Twelve patients with TRD who had not responded to a number of antidepressant trials (n=7), or had responded but subsequently suffered a relapse (n=5), were enrolled in an 8-week, open trial of sertraline. Both a completer analysis (n=6) and an intent-to-treat (ITT) analysis (n=12) were performed to evaluate sertraline response rates. Using a completer analysis, four patients (66.6%) were classified as responders; one (16.7%) as a partial responder and one (16.7%) as a non-responder. An ITT analysis resulted in five (41.7%) patients being classified as responders; one (8.3%) as a partial responder and six (50%) as non-responders. Of the four responders in the completer analysis, three (50%) achieved remission. Of the five responders in the ITT analysis, four (33.3%) achieved remission. Overall, two of seven (28.6%) non-responders and three of five (60.0%) relapsers responded to sertraline. The present results suggest the potential utility of sertraline for patients with TRD, or those with a history of TRD who responded but later relapsed, and warrant larger, placebo-controlled studies to further explore the potential role of sertraline for such patients.
authors.affiliation: Depression Clinical and Research program, Department of Psychiatry, Massachusetts General Hospital, 156 Parkman Street, WACC #812, Boston, MA 02114, USA. gpapakostas@partners.org
authors.forename: George I
authors.initials: GI
authors.lastname: Papakostas
authors.forename: Timothy
authors.initials: T
authors.lastname: Petersen
authors.forename: John J
authors.initials: JJ
authors.lastname: Worthington
authors.forename: Pamela A
authors.initials: PA
authors.lastname: Roffi
authors.forename: Jonathan E
authors.initials: JE
authors.lastname: Alpert
authors.forename: Maurizio
authors.initials: M
authors.lastname: Fava
authors.forename: Andrew A
authors.initials: AA
authors.lastname: Nierenberg
mesh_terms: D000328:Adult; D000928:Antidepressive Agents / Q000008:administration & dosage / Q000494:pharmacology* / Q000627:therapeutic use*; D003866:Depressive Disorder / Q000188:drug therapy* / Q000523:psychology*; D005260:Female; D006801:Humans; D008297:Male; D008875:Middle Aged; D012008:Recurrence; D020280:Sertraline / Q000008:administration & dosage / Q000494:pharmacology* / Q000627:therapeutic use*; D012720:Severity of Illness Index; D016896:Treatment Outcome
chemical_list: D000928:Antidepressive Agents; D020280:Sertraline