Remission rates with 3 consecutive antidepressant trials: effectiveness for depressed outpatients

J Clin Psychiatry. 2005 Jun;66(6):670-6. doi: 10.4088/jcp.v66n0601.

Abstract

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 anti-depressant 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.

Publication types

  • Clinical Trial
  • Comparative Study
  • Randomized Controlled Trial
  • Research Support, N.I.H., Extramural
  • Research Support, Non-U.S. Gov't
  • Research Support, U.S. Gov't, P.H.S.

MeSH terms

  • Adult
  • Ambulatory Care*
  • Antidepressive Agents / therapeutic use*
  • Clinical Protocols / standards
  • Depressive Disorder, Major / diagnosis
  • Depressive Disorder, Major / drug therapy*
  • Depressive Disorder, Major / psychology
  • Double-Blind Method
  • Drug Administration Schedule
  • Female
  • Fluoxetine / therapeutic use
  • Humans
  • Imipramine / therapeutic use
  • Male
  • Patient Compliance
  • Placebos
  • Psychiatric Status Rating Scales
  • Pyrimidines / therapeutic use
  • Secondary Prevention
  • Serotonin Uptake Inhibitors / therapeutic use
  • Treatment Outcome

Substances

  • Antidepressive Agents
  • Placebos
  • Pyrimidines
  • Serotonin Uptake Inhibitors
  • Fluoxetine
  • gepirone
  • Imipramine