Chi-Un Pae Prakash S. Masand Kathleen Peindl Paolo Mannelli Changsu Han David M. Marks Ashwin A. Patkar
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Objectives: Although selective serotonin reuptake
inhibitors (SSRIs) have become the standard of care for the treatment of
major depressive disorder (MDD), limited data exist to support their use
in MDD with atypical features. The current study investigates the efficacy
of the SSRI escitalopram in an 8-week, open-label, flexible-dose,
rater-blinded trial.
Method: Seventeen DSM-IV MDD subjects aged from 18
through 65 years completed screening procedures, provided informed
consent, and went through a minimum 2-week washout from preexisting
antidepressants except fluoxetine (a minimum 4-week washout). They
subsequently received escitalopram (10-20 mg/day) for 8 weeks. The primary
efficacy measure was a change in score from baseline to end of treatment
on the Structured Interview Guide for the Hamilton Rating Scale for
Depression-Seasonal Affective Disorder version (SIGH-SAD), which includes
a set of items for atypical symptoms. Secondary efficacy measures were
defined as changes from baseline to end of treatment in scores on the
SIGH-SAD atypical symptoms subscale (consisting of 8 items specific to
atypical features), Beck Depression Inventory-II, Beck Anxiety Inventory,
Sheehan Disability Scale, and Epworth Sleepiness Questionnaire. The study
was conducted from October 2005 to November 2006.
Results: The mean age was 43.9 years, and 70.6% of
subjects were women. The dropout rate was 11.8% (N = 2/17). The mean dose
of escitalopram was 18.3 mg/day. The total SIGH-SAD score (mean ± SD)
reduced by 53.8% from baseline (33.3 ± 8.2) to end of treatment (15.4 ±
9.4) (t = 4.24, p < .001). The atypical symptoms subscale score reduced by
44.5% from baseline (11.0 ± 4.3) to end of treatment (6.1 ± 2.8) (t =
5.26, p = .001). Ten subjects (62.5%) were classified as responders at end
of treatment as defined by >= 50% reduction in SIGH-SAD total score.
Overall, escitalopram was well tolerated.
Conclusions: Our preliminary study indicates that
escitalopram may be beneficial in the treatment of MDD with atypical
features. Adequately powered, randomized, double-blind, placebo-controlled
trials are necessary to determine the efficacy of escitalopram in this
disorder.
Prim Care Companion J Clin Psychiatry 2008;10(3):205-210
https://doi.org/10.4088/PCC.v10n0305
© Copyright 2008 Physicians Postgraduate Press, Inc.