Predictors of Relapse During Fluoxetine Continuation or Maintenance Treatment of Major Depression
J Clin Psychiatry 2000;61:518-524
© Copyright 2014 Physicians Postgraduate Press, Inc.
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Background: The goal was to examine
predictors of relapse during continuation/maintenance treatment
of major depression that had remitted following 12 to 14 weeks of
Method: The study utilizes data collected
in a collaborative clinical trial including patients with
DSM-III-R major depression at 5 university-affiliated outpatient
psychiatry clinics. Three hundred ninety-five patients who
remitted with fluoxetine therapy were randomly assigned to 1 of 4
treatments: fluoxetine for 14 weeks followed by placebo for 36
weeks, fluoxetine for 38 weeks followed by placebo for 12 weeks,
fluoxetine for 50 weeks, or placebo for 50 weeks. Cox
proportional hazard models were used to identify predictors of
time to relapse.
Results: In addition to the previously
reported longitudinal pattern of response during acute treatment,
neurovegetative symptom pattern was a predictor of fluoxetine
benefit compared with placebo. Greater chronicity predicted
poorer survival, which was not differential by treatment. The
most robust advantage of fluoxetine was seen for patients with
endogenous vegetative symptoms, chronic depression, and acute
treatment response characterized by onset in the third week or
later and persistence of response once attained.
Conclusion: Both nonspecific pattern of
response and neurovegetative symptoms characteristic of atypical
depression were predictive of lack of fluoxetine efficacy in
continuation/maintenance treatment. These findings have
importance for both clinical management and analyses of future