TITLE

Duloxetine in the treatment of Major Depressive Disorder: A comparison of efficacy in patients with and without melancholic features

AUTHOR(S)
Mallinckrodt, Craig H.; Watkin, John G.; Chaofeng Liu; Wohlreich, Madelaine M.; Raskin, Joel
PUB. DATE
January 2005
SOURCE
BMC Psychiatry;2005, Vol. 5, p1
SOURCE TYPE
Academic Journal
DOC. TYPE
Article
ABSTRACT
Background: The most prominent feature of melancholic depression is a near-total loss of the capacity to derive pleasure from activities or other positive stimuli. Additional symptoms can include psychomotor disturbances, anorexia, excessive guilt, and early awakening from sleep. Melancholic patients may exhibit treatment responses and outcomes that differ from those of non-melancholic patients. Pooled data from double-blind, placebo-controlled studies were utilized to compare the efficacy of duloxetine in depressed patients with and without melancholic features. Methods: Efficacy data were pooled from 8 double-blind, placebo-controlled clinical trials of duloxetine. The presence of melancholic features (DSM-IV criteria) was determined using results from the Mini International Neuropsychiatric Interview (MINI). Patients (aged ≥ 18 years) meeting DSM-IV criteria for major depressive disorder (MDD) received duloxetine (40-120 mg/d; melancholic, N = 759; non-melancholic, N = 379) or placebo (melancholic, N = 519; non-melancholic, N = 256) for up to 9 weeks. Efficacy measures included the 17-item Hamilton Rating Scale for Depression (HAMD17) total score, HAMD17 subscales (Maier, anxiety, retardation, sleep), the Clinical Global Impression of Severity (CGI-S) and Patient Global Impression of Improvement (PGI-I) scales, and Visual Analog Scales (VAS) for pain. Results: In data from all 8 studies, duloxetine's advantage over placebo did not differ significantly between melancholic and non-melancholic patients (treatment-by-melancholic status interactions were not statistically significant). Duloxetine demonstrated significantly greater improvement in depressive symptom severity, compared with placebo, within both melancholic and non-melancholic cohorts (p ≤ .001 for HAMD17 total score, CGI-S and PGI-I). When analyzed by gender, the magnitude of improvement in efficacy outcomes did not differ significantly between duloxetine-treated male and female melancholic patients. In the two studies that assessed duloxetine 60 mg once-daily dosing, duloxetine-treated melancholic patients had significantly greater improvement compared with placebo on HAMD17 total score, CGI-S, PGII, 3 of 4 subscales of the HAMD17, and VAS overall pain severity (p < .01). Estimated probabilities of response and remission were significantly greater for melancholic patients receiving duloxetine 60 mg QD compared with placebo (response 74.7% vs. 42.2%, respectively, p < .001; remission 44.4% vs. 24.7%, respectively, p = .002 Conclusions: In this analysis of pooled data, the efficacy of duloxetine in patients with melancholic features did not differ significantly from that observed in non-melancholic patients.
ACCESSION #
29323684

 

Related Articles

  • Intervenciones psicol�gicas y farmacol�gicas para dejar de fumar en fumadores con un trastorno depresivo. V�ZQUEZ, FERNANDO L. // Clinica y Salud;2005, Vol. 16 Issue 3, p269 

    This paper reviews the results of randomized clinical trials of psychological and/or pharmacological treatments for smokers. Special attention has been devoted to subjects with or without a history of depressive disorder. A 6 to 12 months biochemically validated abstinence was used as main...

  • Medication Augmentation after the Failure of SSRIs for Depression. Trivedi, Madhukar H.; Fava, Maurizio; Wisniewski, Stephen R.; Thase, Michael E.; Quitkin, Frederick; Warden, Diane; Ritz, Louise; Nierenberg, Andrew A.; Lebowitz, Barry D.; Biggs, Melanie M.; Luther, James F.; Shores-Wilson, Kathy; Rush, A. John // New England Journal of Medicine;3/23/2006, Vol. 354 Issue 12, p1243 

    Background: Although clinicians frequently add a second medication to an initial, ineffective antidepressant drug, no randomized controlled trial has compared the efficacy of this approach. Methods: We randomly assigned 565 adult outpatients who had nonpsychotic major depressive disorder without...

  • The effect of forewarning on the occurrence of side-effects and discontinuance of medication in patients on amitriptyline. Myers, E. D.; Calvert, E. J. // British Journal of Psychiatry;Apr73, Vol. 122 Issue 569, p461 

    The article discusses the study on the impact of prevising patients taking amitriptyline on its side-effects. It is believed that psychological factors are significant in identifying the harmful or good effects of drugs. In an amitriptyline trial, patients were asked to note down their...

  • Antidepressant treatment history and drug-placebo separation in a placebo-controlled trial in major depressive disorder. Hunter, Aimee; Cook, Ian; Tartter, Molly; Sharma, Simi; Disse, Gregory; Leuchter, Andrew // Psychopharmacology;Oct2015, Vol. 232 Issue 20, p3833 

    Rationale: A history of antidepressant treatment may predispose subjects toward placebo nonresponse in randomized controlled trials (RCTs) in major depressive disorder (MDD). Objective: The objective of this study is to examine self-reported prior antidepressant treatment and response in...

  • St John's wort is at least as effective as paroxetine in reducing severity of depression and is better tolerated. Ernst, Edzard // Evidence Based Mental Health;Nov2005, Vol. 8 Issue 4, p107 

    This article presents a study which found that Saint John's wort is at least as effective as paroxetine in reducing severity of depression and is better tolerated. This randomised controlled trial is one in a long list of studies suggesting that Saint John's wort extracts are efficacious for...

  • What Shapes Depressed Individuals' Pre-Treatment Expectation in Antidepressant Clinical Trials? Moses, Tally; Leuchter, Andrew F.; Cook, Ian; Abrams, Michelle // Internet Journal of Mental Health;2007, Vol. 3 Issue 2, p2 

    Objective: To examine the relationship between patients' treatment outcome expectation and a set of socio-demographic factors, clinical course variables, symptom severity, health locus of control, and Temperament and Character Inventory (TCI) dimensions. Method: Logistic regression analyses were...

  • Which class of antidepressants is most effective and best tolerated by patients with major depression? Sparano, Nicole // Journal of Family Practice;Oct2000, Vol. 49 Issue 10, p886 

    The article examines the classes of antidepressants that are effective and tolerated by patients with major depression. In 1993 the Agency for Health Care Policy and Research published guidelines for the treatment of major depression that focused on the efficacy of older antidepressants,...

  • Comparing Gabapentin with Clonazepam for Residual Sleeping Problems following Antidepressant Therapy in Patients with Major Depressive Disorder: A Randomized Clinical Trial. Mowla, Arash; Ahmadzadeh, Laaya; Razeghian Jahromi, Leila; Dastgheib, Seyed // Clinical Drug Investigation;Aug2015, Vol. 35 Issue 8, p513 

    Background and Objective: Residual sleeping disturbances after improvement of depression in major depressed patients are associated with more functional problems, increased relapses and more risk of becoming resistant to treatment. The aim of this study was to compare the efficacy of gabapentin...

  • A guide to switching antidepressant therapy. Ferentz, Kevin Scott // Patient Care;Jan2007, Vol. 41 Issue 1, p16 

    The article discusses the Sequenced Treatment Alternatives to Relieve Depression study funded by the National Institutes of Health's National Institute of Mental Health (NIMH) in the U.S. The study is designed to examine the effectiveness of different treatment strategies for those who did not...

Share

Read the Article

Courtesy of THE LIBRARY OF VIRGINIA

Sorry, but this item is not currently available from your library.

Try another library?
Sign out of this library

Other Topics