Remission rates with 3 consecutive antidepressant trials: effectiveness for depressed outpatients.
OBJECTIVE
This effectiveness study assessed remission rates in patients who had the opportunity to receive up to 3 antidepressant trials if unresponsive.


METHODS
One hundred seventy-one consecutive outpatients entered 1 of 3 studies for the treatment of major depressive disorder (DSM-IV criteria) from January 1999 through December 2001. This group primarily received fluoxetine as a first treatment in trials lasting 6 to 12 weeks (a small number received gepirone). If unimproved, patients received a second or third trial (primarily clinician's choice). A standard criterion to determine remission-a score of 7 or less on the 17-item Hamilton Rating Scale for Depression-was used. In order to contrast remission rates with first-generation antidepressants, patients' outcomes in a previously published study that compared placebo, phenelzine, and imipramine were also examined (N = 420).


RESULTS
In an intent-to-treat analysis, 66% (113/171) of patients who were treated with second-generation antidepressants and 65% (275/420) of patients who were treated with first-generation antidepressants eventually achieved remission.


CONCLUSIONS
Remission rates in the effectiveness study are approximately 20% higher than the rates usually cited, a result of our choice to examine outcome following 3 treatment trials. This choice is dictated by good clinical practice. The usual procedure when comparing treatment modalities is to assess outcome after a single anti-depressant trial. The cumulative high remission rates suggest antidepressants are effective and should encourage more patients to seek treatment and physicians to develop techniques to improve patient adherence.
Quitkin
Frederic M
FM
Department of Therapeutics, Columbia University College of Physicians and Surgeons, New York State Psychiatric Institute, New York, USA.
McGrath
Patrick J
PJ
Stewart
Jonathan W
JW
Deliyannides
Deborah
D
Taylor
Bonnie P
BP
Davies
Carrie A
CA
Klein
Donald F
DF
D000328:Adult; D000553:Ambulatory Care; D000928:Antidepressive Agents / Q000627:therapeutic use*; D002985:Clinical Protocols / Q000592:standards; D003865:Major Depressive Disorder / Q000175:diagnosis / Q000188:drug therapy* / Q000523:psychology; D004311:Double-Blind Method; D004334:Drug Administration Schedule; D005260:Female; D005473:Fluoxetine / Q000627:therapeutic use; D006801:Humans; D007099:Imipramine / Q000627:therapeutic use; D008297:Male; D010349:Patient Compliance; D010919:Placebos; D011569:Psychiatric Status Rating Scales; D011743:Pyrimidines / Q000627:therapeutic use; D055502:Secondary Prevention; D017367:Selective Serotonin Reuptake Inhibitors / Q000627:therapeutic use; D016896:Treatment Outcome
D000928:Antidepressive Agents; D005473:Fluoxetine; D007099:Imipramine; D010919:Placebos; D011743:Pyrimidines; D017367:Selective Serotonin Reuptake Inhibitors; C039979:gepirone