Remission in major depression with two antidepressant mechanisms: results from a naturalistic study.
BACKGROUND
Since remission should be the goal of the treatment of depression, the aims of this study were to evaluate the rate of remission obtained with SSRIs in routine clinical practice and to assess alternative treatments with a combined mechanism of action.


METHODS
The study involved a prospective naturalistic 6-month follow-up of 44 consecutive unipolar depressed (DSM-IV) outpatients. After 6 weeks of treatment with a SSRI, patients were classified as remitted (HAM-D-17 score <==7), partial responders (>/=50% reduction in HAM-D-17 score but still higher than 7) and non-responders. In case of non-response, an antidepressant with noradrenergic action (NaA) was added to the ongoing SSRI treatment or were switched to venlafaxine in monotherapy when NaA was contraindicated.


RESULTS
At 6 weeks, eight patients (18.1%) achieved full remission, nine patients (20.5%) were partial responders and 27 (61.4%) non responders. At the end of follow-up 31.8% (n=14) of the initial sample remained remitted with SSRIs, whereas 96.2% (26/27) of previous non-responders experienced remission with the alternative treatment. Non-responders to SSRIs in monotherapy were significantly more likely to show melancholic features and to have higher HAM-D-17 scores and lower GAF scores than remitted patients with SSRIs.


CONCLUSIONS
the observational and naturalistic design of the study determines inherent limitations.


CONCLUSIONS
this study showed a low remission rate with SSRIs in the long-term treatment of more severe and melancholic depression, and the benefit of using treatments with a combined mechanism of action.
Montes
José Manuel
JM
Hospital Universitario Príncipe de Asturias, Universidad de Alcalá, Madrid, Spain. j_m_montes@hotmail.com
Ferrando
Laura
L
Saiz-Ruiz
Jerónimo
J
D000328:Adult; D000368:Aged; D000928:Antidepressive Agents / Q000627:therapeutic use*; D003866:Depressive Disorder / Q000188:drug therapy* / Q000523:psychology; D023381:Endpoint Determination; D005260:Female; D005500:Follow-Up Studies; D006801:Humans; D008297:Male; D008875:Middle Aged; D017367:Selective Serotonin Reuptake Inhibitors / Q000627:therapeutic use*; D012720:Severity of Illness Index; D016896:Treatment Outcome
D000928:Antidepressive Agents; D017367:Selective Serotonin Reuptake Inhibitors