Paroxetine Response and Tolerability Among Ethnic Minority Patients With Mood or Anxiety Disorders: A Pooled Analysis
J Clin Psychiatry 2005;66(10):1228-1233
© Copyright 2014 Physicians Postgraduate Press, Inc.
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Background: Because of the poor quality
of mental health care received by minorities,
analyses documenting comparable response to and tolerability of medications for anxiety and
depression in large samples of minority and majority populations could increase the willingness
of providers and patients to use medications in minority populations.
Method: A pooled analysis of 14,875
adults who participated in 104 double-blind,
placebo-controlled paroxetine clinical trials
investigating major depression, panic disorder,
generalized anxiety disorder, social anxiety disorder,
obsessive-compulsive disorder, posttraumatic
stress disorder, or premenstrual dysphoric disorder
from March 1984 through March 2002. An intent-to-treat analysis with last observation carried
forward used the Clinical Global Impressions (CGI) scale to measure dichotomous outcome,
classified as either response (CGI score of 1 or 2) or
more complete response (CGI score of 1) ("full
response"). Minority group differences were
examined using logistic regression for the entire sample and repeated for those with major
depression. Adverse events greater than 5% and
twice the rate of placebo were descriptively
tabulated. Finally, a survival analysis examined group
differences in speed of onset of response.
Results: Hispanic and Asian subjects had
a slightly lower response rate, while Asians had
the highest rates and Hispanics had the lowest
rates of "full response." The more consistent
Hispanic outcome differences appeared to be due to
a higher placebo response rate. There was no treatment by minority group interaction for
depressed patients. Speed of response and adverse
effects were similar across groups.
Conclusions: There were few consistent
differences in medication response and
tolerability. These findings may serve to counteract
the greater rate of negative attitudes toward
medication use among minorities and reinforce the
value of medications used to treat anxiety and
depression in minorities.