Dual Reuptake Inhibitors Incur Lower Rates of Tachyphylaxis Than Selective Serotonin Reuptake Inhibitors: A Retrospective Study
J Clin Psychiatry 2005;66(6):705-707
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Background: The notion that selective serotonin
reuptake inhibitors (SSRIs) may be associated with higher relapse
rates than other antidepressants during maintenance treatment
(tachyphylaxis) has been discussed for years, but to date there
is little or no empirical evidence confirming this phenomenon. In
this study, we systematically assessed prior antidepressant
treatment history in a cohort of depressed patients who presented
for outpatient psychiatric treatment. Rates of tachyphylaxis were
compared in venlafaxine and tricyclic antidepressants (TCAs),
which act as dual reuptake inhibitors, versus SSRIs.
Method: 237 patients who presented for treatment
at the Rhode Island Hospital Department of Psychiatry's
outpatient practice and were diagnosed with DSM-IV major depressive
disorder were interviewed with the semistructured Treatment
Response to Antidepressant Questionnaire. This cohort reported
having undergone 326 prior SSRI trials, 47 prior venlafaxine
trials, and 35 prior trials with a TCA. Rates of tachyphylaxis as
a function of antidepressant class were compared.
Results: Rates of tachyphylaxis were significantly lower (chi 2= 6.77, df = 1, p = .01) with the
dual reuptake inhibitors venlafaxine and TCAs (3 [3.7%] of 82)
compared to rates of tachyphylaxis with SSRIs (46 [14.1%] of
Conclusion: These results provide preliminary
evidence that dual reuptake inhibitors may incur lower rates of
tachyphylaxis than SSRIs. By virtue of the retrospective and
nonrandom design of the study, these results warrant