An Open Trial of Reboxetine in HIV-Seropositive Outpatients With Major Depressive Disorder
J Clin Psychiatry 2003;64(4):421-424
© Copyright 2015 Physicians Postgraduate Press, Inc.
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Background: The prevalence of major depressive
disorder (MDD) in human immunodeficiency virus (HIV)-seropositive
patients is higher than in the general population. The treatment
of comorbidities of HIV infection, such as depression, is an
important target in the clinical management of these patients.
The use of antidepressants in HIV patients can be complicated by
the pharmacokinetic interaction between antidepressants and
antiretroviral agents. Several antidepressants and
antiretrovirals are metabolized by cytochrome P450 (CYP450).
Reboxetine is a noradrenergic antidepressant that is not
metabolized by CYP450 and may offer a valuable option in the
treatment of MDD in HIV-seropositive patients.
Method: Twenty HIV-infected outpatients with MDD
according to DSM-IV criteria were treated with reboxetine, 8
mg/day, for 12 weeks within an open trial design. Outcome
measures included the Montgomery-Asberg Depression Rating Scale
(MADRS) and a side effect profile. Data were gathered from July
2000 to March 2001.
Results: Seventy-five percent of patients
(N = 15) completed the trial. All patients who completed the
trial had an improvement equal to or higher than a 50% reduction
in their MADRS scores at endpoint. The most frequent adverse
effects were insomnia, sweating, and shivering.
Conclusion: Within this open trial,
reboxetine was found to be effective in reducing depressive
symptoms in HIV illness. The rate of dropout (25%) suggests that
reboxetine may be well tolerated in this population.