Frederic M. Quitkin, MD; Patrick J. McGrath, MD; Jonathan W. Stewart, MD; Deborah Deliyannides, MD; Bonnie P. Taylor, PhD; Carrie A. Davies, BS; and Donald F. Klein, MD
Objective: This effectiveness study assessed
remission rates in patients who had the opportunity to receive up
to 3 antidepressant trials if unresponsive.
Method: One hundred seventy-one
consecutive outpatients entered 1 of 3 studies for the treatment
of major depressive disorder (DSM-IV criteria) from January 1999
through December 2001. This group primarily received fluoxetine
as a first treatment in trials lasting 6 to 12 weeks (a small
number received gepirone). If unimproved, patients received a
second or third trial (primarily clinician's choice). A standard
criterion to determine remission--a score of 7 or less on the
17-item Hamilton Rating Scale for Depression--was used. In order
to contrast remission rates with first-generation
antidepressants, patients' outcomes in a previously published
study that compared placebo, phenelzine, and imipramine were also
examined (N = 420).
Results: In an intent-to-treat analysis,
66% (113/171) of patients who were treated with second-generation
antidepressants and 65% (275/420) of patients who were treated
with first-generation antidepressants eventually achieved
remission.
Conclusions: Remission rates in the
effectiveness study are approximately 20% higher than the rates
usually cited, a result of our choice to examine outcome
following 3 treatment trials. This choice is dictated by good
clinical practice. The usual procedure when comparing treatment
modalities is to assess outcome after a single antidepressant
trial. The cumulative high remission rates suggest
antidepressants are effective and should encourage more patients
to seek treatment and physicians to develop techniques to improve
patient adherence.
J Clin Psychiatry 2005;66(6):670-676
© Copyright 2005 Physicians Postgraduate Press, Inc.