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Combined treatment with reboxetine in depressed patients with no response to venlafaxine: a 6-week follow-up study

Published online by Cambridge University Press:  24 June 2014

Cecilio Álamo ,
Francisco López-Muñoz ,
Gabriel Rubio ,
Pilar García-García  and
Antonio Pardo
Cecilio Álamo
Affiliation:
Pharmacology Department, Faculty of Medicine, University of Alcalá, Madrid, Spain
Francisco López-Muñoz*
Affiliation:
Pharmacology Department, Faculty of Medicine, University of Alcalá, Madrid, Spain
Gabriel Rubio
Affiliation:
Retiro Mental Health Services, Department of Psychiatry, Complutense University, Madrid, Spain
Pilar García-García
Affiliation:
Pharmacology Department, Faculty of Medicine, University of Alcalá, Madrid, Spain
Antonio Pardo
Affiliation:
Department of Social Psychology and Methodology, Faculty of Psychology, Autonome University, Madrid, Spain
*
Francisco López-Muñoz, MD, PhD, Pharmacology Department, University of Alcalá, C/Juan Ignacio Luca de Tena 8, 28027 Madrid, Spain. Tel: +34 91 7248210; Fax: +34 91 7248205; E-mail: [email protected]
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Abstract

Objective:

The purpose of present study was to evaluate the efficacy of the addition of reboxetine in patients that had not previously responded, or had done so only partially, over 6 weeks of conventional pharmacological treatment with venlafaxine.

Methods:

This open-label, prospective and multicentric study included 40 outpatients diagnosed with major depressive disorder according to the DSM-IV criteria. Efficacy was assessed using the 21-item Hamilton Depression Rating Scale (HAMD) and the Clinical Global Impression-Improvement (CGI-I). Safety was evaluated by recording spontaneously reported adverse events. Data were analysed on an intent-to-treat basis, using the last-observation-carried-forward method.

Results:

Mean HAMD reduction was 34.9% (P < 0.0001). The percentages of responders (≥50% reduction in HAMD) and patients considered as benefiting from complete remission (HAMD ≤ 10 points) at week 6 were 27.5 and 12.5%, respectively. By the end of the treatment, the score of CGI-I decreased 24.8% (P < 0.0001). Percentage of patient improving (CGI < 4 points) was 47.5%. The most common non-serious adverse events were constipation, nervousness, anxiety and insomnia.

Conclusion:

These findings suggest that the combined treatment of reboxetine and venlafaxine, in venlafaxine-resistant patients, may be an effective and well-tolerated strategy.

Keywords

combination treatmentmajor depressive disorderreboxetineresistant depressionvenlafaxine
Type
Research Article
Information
Acta Neuropsychiatrica , Volume 19 , Issue 5 , October 2007 , pp. 291 - 296
Copyright
Copyright © 2007 Blackwell Munksgaard

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References

Blazer, DG, Kessler, RC, McGonagle, KA, Swartz, MS. The prevalence and distribution of major depression in a national community sample: the National Comorbidity Survey. Am J Psychiatry 1994;151:979–986. Google Scholar
Lepine, JP, Gastpar, M, Mendlewicz, J, Tylee, A. Depression in the community: the first pan-European study DEPRES (Depression Research in European Society). Int Clin Psychopharmacol 1997;12:19–29. CrossRefGoogle ScholarPubMed
Amsterdam, JD, Hornig-Rohan, M. Treatment algorithms in treatment-resistant depression. Psychiatr Clin North Am 1996;19:371–386. CrossRefGoogle ScholarPubMed
Nemeroff, CB. Augmentation strategies in patients with refractory depression. Depress Anxiety 1997;4:169–181. 3.0.CO;2-A>CrossRefGoogle Scholar
Nierenberg, AA, Amsterdam, JD. Resistant depression: definition and treatment approaches. J Clin Psychiatry 1990;51:S39–S47. Google ScholarPubMed
Rojo, JE, Ros, S, Agüera, L, De La Gándara, J, De Pedro, JM. Combined antidepressant: clinical experience. Acta Psychiatr Scand 2005;112:25–31. CrossRefGoogle Scholar
Sokolov, STH, Joffe, RT. Practical guidelines for combination drug therapy of treatment-resistant depression. CNS Drugs 1995;4:341–350. CrossRefGoogle Scholar
Dierick, M, Ravizza, L, Realini, R, Martin, A. A double-blind comparison of venlafaxine and fluoxetine for treatment of major depression in outpatients. Prog Neuropsychopharmacol Biol Psychiatry 1996;20:57–71. CrossRefGoogle ScholarPubMed
Lecrubier, Y, Bourin, M, Moon, CALet al. Efficacy of venlafaxine in depressive illness in general practice. Acta Psychiatr Scand 1997;95:485–493. CrossRefGoogle ScholarPubMed
Entsuah, AR, Huang, H, Thase, ME. Response and remission rates in different subpopulations with major depressive disorder administered venlafaxine, selective serotonin reuptake inhibitor, or placebo. J Clin Psychiatry 2001;62:869–877. CrossRefGoogle ScholarPubMed
Gaynes, B, Davis, L, Rush, J, Trivedi, M, Fava, M, Wisniewski, S. The aims and design of the sequenced treatment alternatives to relieve depression (STAR*D) Study. Prim Psychiatr 2005;12:36–41. Google Scholar
Joffe, RT. Substitution therapy in patients with major depression. CNS Drugs 1999;11:175–180. CrossRefGoogle Scholar
Kelsey, JE. Switching drug class after initial SSRI failure. J Clin Psychiatry 1997;583:326–327. CrossRefGoogle Scholar
Nelson, JC. Augmentation strategies in depression. J Clin Psychiatry 2000;61(Suppl. 2):13–19. Google ScholarPubMed
Dodd, S, Horgan, D, Malhi, GS, Berk, M. To combine or not to combine? A literature review of antidepressant combination therapy. J Affect Disord 2005;89:1–11. CrossRefGoogle ScholarPubMed
Lam, WL, Wan, D, Cohen, N, Kennedy, S. Combining antidepressant for treatment-resistant depression: a review. J Clin Psychiatry 2002;63:685–693. CrossRefGoogle ScholarPubMed
Trivedi, MH, Fava, M, Wisniewski, SRet al. and STAR*D Study Team. Medication augmentation after the failure of SSRI for depression. N Engl J Med 2006;354:1305–1307. CrossRefGoogle Scholar
Zisook, S, Rush, AJ, Haight, BR, Clines, DC, Rockett, CB. Use of bupropion in combination with serotonin reuptake inhibitors. Biol Psychiatry 2006;59:203–210. CrossRefGoogle ScholarPubMed
De Montigny, C, Silverstone, PH, Debonnel, G, Blier, P, Bakish, D. Venlafaxine for treatment resistant depression: a Canadian multi-center, open label trial. J Clin Psychopharmacol 1999;19:401–406. CrossRefGoogle Scholar
Nierenberg, AA, Feighner, J, Rudolph, R. Venlafaxine for treatment resistant unipolar depression. J Clin Psychopharmacol 1994;14:419–423. CrossRefGoogle ScholarPubMed
Sáiz-Ruiz, J, Ibañez, A, Díaz-Marsá, Met al. Eficacia de la venlafaxina en pacientes depresivos resistentes o que no toleran inhibidores selectivos de la recaptación de serotonina. Psiquiatr Biol 1999;6:106–112. Google Scholar
Carpenter, LL, Jocic, Z, Hall, JM, Rasmussen, SA, Price, LH. Mirtazapine augmentation in the treatment of refractory depression. J Clin Psychiatry 1999;60:45–49. CrossRefGoogle ScholarPubMed
Craig, J. Managing treatment-resistant major depression. J Clin Psychiatry 2003;64:5–12. Google Scholar
Gonul, AS, Akdeniz, F, Donat, O, Vahip, S. Selective serotonin reuptake inhibitors combined with venlafaxine in depressed patients who had partial response to venlafaxine: four cases. Prog Neuropsychopharmacol Biol Psychiatry 2003;27:889–891. CrossRefGoogle ScholarPubMed
Kennedy, SH, McCann, SM, Masellis, Met al. Combining bupropion SR with venlafaxine, paroxetine, or fluoxetine: a preliminary report on pharmacokinetic, therapeutic, and sexual dysfunction effects. J Clin Psychiatry 2002;63:181–186. CrossRefGoogle ScholarPubMed
Rubio, G, San, L, López-Muñoz, F, Alamo, C. Reboxetine adjunct for partial or nonresponders to antidepressant treatment. J Affect Disord 2004;81:67–72. CrossRefGoogle ScholarPubMed
Hoencamp, E, Haffmans, J, Dijken, W, Huijbrechts, I. Lithium augmentation of venlafaxine: an open-label trial. J Clin Psychopharmacol 2000;20:538–543. CrossRefGoogle ScholarPubMed
Wong, EHF, Sonders, MS, Amara, SGet al. Reboxetine: a pharmacologically potent, selective, and specific norepinephrine reuptake inhibitor. Biol Psychiatry 2000;47:818–829. CrossRefGoogle ScholarPubMed
Berzewski, H, Van Moffaert, M, Gagiano, CA. Efficacy and tolerability of reboxetine compared with imipramine in a double-blind study in patients suffering from major depressive episodes. Eur Neuropsychopharmacol 1997;7(Suppl. 1):37–47. CrossRefGoogle Scholar
Versiani, M, Mohammed, A, Guy, CH. Double-blind, placebo-controlled study with reboxetine in inpatients with severe major depressive disorder. J Clin Psychopharmacol 2000;20:28–34. CrossRefGoogle ScholarPubMed
Tanum, L. Reboxetine: tolerability and safety profile in patients with major depression. Acta Psychiatr Scand 2000;101(Suppl. 402):37–40. CrossRefGoogle Scholar
Hirschfeld, RM, Montgomery, SA, Aguglia, E et al. Partial response and nonresponse to antidepressant therapy: current approaches and treatment options. J Clin Psychiatry 2002;63:826–837. CrossRefGoogle ScholarPubMed
Stanley, B. An integration of ethical and clinical considerations in the use of placebos. Psychopharmacol Bull 1988;24:180–220. Google ScholarPubMed
Danjou, P, Hackett, D. Safety and tolerance profile of venlafaxine. Int Clin Psychopharmacol 1995;10(Suppl. 2):15–20. CrossRefGoogle ScholarPubMed
Fleishaker, JC. Clinical pharmacokinetics of reboxetine, a selective norepinephrine reuptake inhibitor for the treatment of patients with depression. Clin Pharmacokinet 2000;39:413–427. CrossRefGoogle ScholarPubMed
Gómez, JM, Teixido, C. Combined treatment with venlafaxine and tricyclic antidepressants in depressed patients who had partial response to clomipramine or imipramine: initial findings. J Clin Psychiatry 2000;61:285–289. Google Scholar
Rubio, G, San, L, López-Muñoz, F, García-García, P, ÁLamo, C. Tratamiento de combinación con reboxetina en pacientes con depresión mayor no respondedores o con respuesta parcial a inhibidores selectivos de la recaptación de serotonina. Actas Esp Psiquiatr 2003;31:315–324. Google Scholar
Horst, WD, Preskorn, SH. The pharmacology and mode of action of venlafaxine. Rev Contemp Pharmacother 1998;9:293–302. Google Scholar
De La Gándara, J, Agüera, L, Ferre, F, Rojo, E, Ros, S. Eficacia y seguridad de la asociación de antidepresivos. Actas Esp Psiquiatr 2002;30:75–84. Google Scholar
Holliday, SM, Bendfield, P. Venlafaxine: a review of its pharmacology and therapeutical potential in depression. Drugs 1995;49:280–294. CrossRefGoogle ScholarPubMed
Bhatara, VS, Magnus, R, Lynn, P, Preskorn, S. Serotonin syndrome induced by venlafaxine and fluoxetine: a case study in polypharmacy and potential pharmacodynamic and pharmacokinetic mechanisms. Ann Pharmacother 1998;32:889–891. CrossRefGoogle ScholarPubMed
Messer, T, Schmauss, M, Lambert-Baumann, J. Efficacy and tolerability of reboxetine in depressive patients treated in routine clinical practice. CNS Drugs 2005;19:43–54. CrossRefGoogle ScholarPubMed