Switching Patients From Daily Citalopram, Paroxetine, or Sertraline to Once-Weekly Fluoxetine in the Maintenance of Response for Depression
J Clin Psychiatry 2002;63(3):232-240
© Copyright 2015 Physicians Postgraduate Press, Inc.
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Background: Major depressive disorder is frequently
a chronic, recurrent condition necessitating maintenance
treatment. For some patients, compliance with daily
pharmacotherapy is difficult over time. As an alternative approach,
a once-weekly administered formulation of fluoxetine has
recently been made available. This raises the important
question of whether once-weekly enteric-coated fluoxetine, 90 mg,
is effective for maintenance of response in patients whose
depressive symptoms have responded to daily dosing with
selective serotonin reuptake inhibitors (SSRIs) such as
citalopram, paroxetine, or sertraline.
Method: Patients had met DSM-IV criteria for major
depressive disorder prior to beginning treatment for their current
episode, had received 6 to 52 weeks of treatment with
citalopram (20-40 mg/day [N=83]), paroxetine (20 mg/day [N=77]),
or sertraline (50-100 mg/day [N=86]), and had responded to
that treatment (Clinical Global Impressions-Severity of
Illness [CGI-S] score 2, modified 17-item Hamilton Rating Scale
for Depression [HAM-D-17] score 10). Patients meeting
these criteria (N=246) continued treatment with their current
SSRI for 1 week, then were switched to open-label
enteric-coated fluoxetine, 90 mg, taken once weekly for 12 weeks.
Safety measures were comparisons of spontaneously reported and
solicited treatment-emergent adverse events. Efficacy
measures were percentages of patients who discontinued the study
for relapse and lack of efficacy and comparison of change
from baseline to endpoint in scores on the modified HAM-D-17,
subscales of the HAM-D-28, and the CGI-S. Quality of life
measures were assessed with the MOS 36-Item Short-Form
Health Survey (SF-36). We hypothesized that the once-weekly
administration of fluoxetine could be safely and effectively
initiated among subjects who had been stabilized on daily SSRI
Results: Seventy-nine percent of patients successfully
completed a switch to enteric-coated fluoxetine, 90 mg, with
9.3% discontinuing due to relapse or lack of efficacy.
Enteric-coated fluoxetine at a once-weekly dose of 90 mg was well tolerated
in all groups. No significant increases were found in the
HAM-D-17 total, HAM-D-28 subscores, or CGI-S score.
Patients showed improvement from baseline to endpoint in most of
the SF-36 health concepts.
Conclusion: Enteric-coated fluoxetine taken once
weekly appears to be well tolerated and efficacious in patients
who responded to acute therapy with other SSRIs and were
subsequently switched to fluoxetine once weekly for