Dual Reuptake Inhibitors Incur Lower Rates of Tachyphylaxis Than Selective Serotonin Reuptake Inhibitors: A Retrospective Study

Michael A. Posternak, M.D., and Mark Zimmerman, M.D.

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 326).

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 confirmation.

(J Clin Psychiatry 2005;66:705-707)

Received June 23, 2004; accepted Nov. 8, 2004. From the Department of Psychiatry and Human Behavior, Brown University School of Medicine, Rhode Island Hospital, Providence.

Dr. Zimmerman has served on speakers or advisory boards for GlaxoSmithKline, Bristol-Myers Squibb, Forest, Pfizer, and Wyeth-Ayerst. Dr. Posternak has no financial affiliation or other relationship relevant to the subject matter of this article.

The authors thank Thao-Ly Phan, B.S., for her assistance with data collection.

Corresponding author and reprints: Michael A. Posternak, M.D., Department of Psychiatry and Human Behavior, Brown University School of Medicine, Rhode Island Hospital, 235 Plain St., Suite 501, Providence, RI 02905 (e-mail: mposternak@lifespan.org).