Augmentation With Open-Label Atomoxetine for Partial or Nonresponse to Antidepressants

Linda L. Carpenter, M.D.; Nada Milosavljevic, M.D., J.D.; Jordan M. Schecter, M.D.; Audrey R. Tyrka, M.D., Ph.D.; and Lawrence H. Price, M.D.

Background: Atomoxetine is a selective norepinephrine reuptake inhibitor currently approved for the treatment of attention-deficit/hyperactivity disorder. Other compounds that enhance synaptic norepinephrine have shown efficacy as antidepressant monotherapies and as augmentation agents. This case series study examined the role of atomoxetine in antidepressant augmentation.

Method: Fifteen adult outpatients with primary DSM-IV Axis I depressive disorders received open-label atomoxetine augmentation following partial response or nonresponse to at least 8 weeks of standard antidepressant pharmacotherapy. Atomoxetine 40 mg/day was added to ongoing medication regimens and titrated according to clinical response. Atomoxetine was systematically offered to patients from July through October 2003.

Results: Eleven patients (73%) completed at least 6 weeks of atomoxetine augmentation. Mean endpoint dose was approximately 80 mg/day. Nine patients (60%) met criteria for positive categorical response. Inventory of Depressive Symptomatology-Self-Report scores decreased significantly from baseline to endpoint, and clinician ratings of social and occupational functioning increased. There were no significant changes in heart rate or blood pressure, and the most common side effect was activation. A modest but significant drop in body mass index was observed (p = .025), and a subset (6/15; 40%) of patients reported improved sexual function.

Conclusion: More studies are warranted to evaluate the potential utility of atomoxetine for antidepressant augmentation.

(J Clin Psychiatry 2005;66:1234-1238)

Received Nov. 15, 2004; accepted Feb. 23, 2005. From the Mood Disorders Research Program, Butler Hospital, Department of Psychiatry and Human Behavior, Brown Medical School, Providence, R.I.

Funded by National Alliance for Research on Schizophrenia and Depression (NARSAD) Young Investigator awards (Drs. Carpenter and Tyrka).

Data presented in part in poster form at the American Psychiatric Association annual meeting (Philadelphia, Pa., 2004), at the Institute for Psychiatric Services annual meeting (Atlanta, Ga., 2004), and at the American College of Neuropsychopharmacology annual meeting (San Juan, Puerto Rico, 2004).

Drs. Carpenter, Milosavljevic, Schecter, Tyrka, and Price report no significant commercial relationships relative to the subject of this article.

The authors wish to thank Kelly Colombo, B.A., of the Butler Hospital Mood Disorders Research Program, for statistical and database expertise.

Corresponding author and reprints: Linda L. Carpenter, M.D., Butler Hospital, 345 Blackstone Blvd., Providence, RI 02906 (e-mail: Linda_Carpenter_MD@Brown.edu).