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Re: It Might Be Worth Knowing ... » sweetmarie

Posted by SalArmy4me on July 13, 2001, at 17:03:11

In reply to It Might Be Worth Knowing ..., posted by sweetmarie on July 13, 2001, at 16:40:48

Clinical Psychopharmacology Seminar
http://www.vh.org/Providers/Conferences/CPS/11.html
Treatment of Refractory Depression
Original Author(s): Bruce Alexander, Pharm.D.

"Two studies of the same design have investigated the effect of duration of treatment on response rate (Dornseif et al 1989, Schweizer et al 1990). Patients were treated with fluoxetine 20 mg/d for 3 weeks. The nonresponders were randomized to receive an additional 5 weeks of fluoxetine 20 mg/d or to have their dose increased to 60 mg/d. After the additional 5 weeks, 50% of patients in both groups responded. Thus, a therapeutic trial of fluoxetine could be considered to be 6 to 8 weeks.

A more recent placebo-controlled study by Quitkin et al (1996) reported on 693 patients treated prospectively with a variety of antidepressant regimens. A response criterion was a sustained score on the CGI of much improved or very much improved. All patients were rated weekly. They concluded that those patients with some improvement in depressive signs/symptoms by week 4 should have their antidepressant regimen continued until week 6. This was based on the observation that 39% (versus 8% of placebo) of patients at week 4 that had minimal improvement were responders at week 6. However, if at week 4 the patient has had no improvement, then the treatment should be changed. This was based on the observation that for drug and placebo only 13% and 6%, respectively went on to respond at week 6.

Conclusion

It is important for comparison purposes that studies of "TRD" include specific details about dose, serum levels, and duration of treatment as well as diagnostic subtypes.

It is generally recommended that a patient should receive at least 4 weeks of an antidepressant at maximal tolerated doses before being considered a treatment failure (Wager and Klein 1988, Shelton 1999). Doses up to 400 mg/d should be considered in a patient that tolerates lower doses..."


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