title: Prophylactic efficacy of fluoxetine, escitalopram, sertraline, paroxetine, and concomitant psychotherapy in major depressive disorder: outcome after long-term follow-up.
abstract: The acute efficacy of selective serotonin reuptake inhibitors (SSRIs) in the treatment of major depressive disorder (MDD) is well established; however their role in longer-term prevention of recurrence remains unconfirmed. This study aims at examining: the prophylactic efficacy of four commonly used SSRIs in MDD in a naturalistic setting with long-term follow-up, the effect of concomitant cognitive behavioral therapy (CBT), and the predictors of outcome. In a prospective cohort study, 387 patients who either remitted or responded following treatment with four different SSRIs-fluoxetine, escitalopram, sertraline and paroxetine-were followed up over several years. During an average follow-up period of 34.5 months, 76.5% of patients experienced MDD recurrence. Escitalopram and fluoxetine showed a numerically higher prophylactic efficacy than paroxetine and sertraline but the difference was statistically insignificant. The prophylactic efficacy for SSRI-only treatment was limited, with a recurrence rate of 82.0%, compared to 59.0% of patient recurrence rate in concomitant Cognitive Behavioral Therapy (CBT). The relatively small size of the CBT group and the lack of randomization may undermine the extrapolation of its findings to clinical practice. Nevertheless, the study preliminary data may help in defining the clinical utility of antidepressants and CBT in the prophylaxis from MDD recurrence.
authors.affiliation: NY Medical College, Richmond University Medical Center and Freedom From Fear, Staten Island, NY, USA.
authors.forename: Eric D
authors.initials: ED
authors.lastname: Peselow
authors.affiliation: Detroit Medical Center, Wayne State University, Department of Psychiatry and Behavioral Neurosciences, Detroit, MI, USA.
authors.forename: Gabriel
authors.initials: G
authors.lastname: Tobia
authors.affiliation: Pepperdine University, Malibu, CA, USA; Department of Psychiatry and Behavioral Neurosciences at Cedars-Sinai Medical Center, Los Angeles, CA, USA.
authors.forename: Reneh
authors.initials: R
authors.lastname: Karamians
authors.affiliation: Pepperdine University, Malibu, CA, USA; Department of Psychiatry and Behavioral Neurosciences at Cedars-Sinai Medical Center, Los Angeles, CA, USA.
authors.forename: Demetria
authors.initials: D
authors.lastname: Pizano
authors.affiliation: Department of Psychiatry and Behavioral Neurosciences at Cedars-Sinai Medical Center, Los Angeles, CA, USA; Department of Psychiatry and Biobehavioral Sciences, David Geffen School of Medicine at UCLA, Los Angeles, CA 90095, USA. Electronic address: Waguih.IsHak@cshs.org.
authors.forename: Waguih William
authors.initials: WW
authors.lastname: IsHak
mesh_terms: D000328:Adult; D015283:Citalopram / Q000627:therapeutic use*; D015928:Cognitive Behavioral Therapy; D015331:Cohort Studies; D003131:Combined Modality Therapy; D003865:Major Depressive Disorder / Q000175:diagnosis / Q000523:psychology / Q000628:therapy*; D005260:Female; D005473:Fluoxetine / Q000627:therapeutic use*; D005500:Follow-Up Studies; D006801:Humans; D008134:Long-Term Care; D008297:Male; D008875:Middle Aged; D017374:Paroxetine / Q000627:therapeutic use*; D011446:Prospective Studies; D012008:Recurrence; D017367:Selective Serotonin Reuptake Inhibitors / Q000627:therapeutic use; D020280:Sertraline / Q000627:therapeutic use*; D016896:Treatment Outcome
chemical_list: D015283:Citalopram; D005473:Fluoxetine; D017374:Paroxetine; D017367:Selective Serotonin Reuptake Inhibitors; D020280:Sertraline
keywords: Escitalopram; Fluoxetine; Long-term follow-up; Major depressive disorder; Paroxetine; Psychotherapy; Sertraline