Partial response, nonresponse, and relapse with selective serotonin reuptake inhibitors in major depression: A survey of current "next-step" practices

被引:107
作者
Fredman, SJ
Fava, M
Kienke, AS
White, CN
Nierenberg, AA
Rosenbaum, JF
机构
[1] Massachusetts Gen Hosp, Mood & Anxiety Disorders Program, Boston, MA 02114 USA
[2] Massachusetts Gen Hosp, Depress Clin & Res Program, Boston, MA 02114 USA
[3] Harvard Univ, Sch Med, Boston, MA 02115 USA
关键词
D O I
10.4088/JCP.v61n0602
中图分类号
B849 [应用心理学];
学科分类号
040203 ;
摘要
Background: Many patients treated for major depression require more than one antidepressant trial to achieve or sustain response However, the literature provides few treatment algorithms or effectiveness studies that empirically support "next-step" options available to clinicians. We conducted a sun ey of psychiatrists and other medical specialists who treat depression to ascertain what clinicians actually do when faced with patients who suboptimally respond to an adequate course of selective serotonin reuptake inhibitor (SSRI) therapy. Method: Attendees at a psychopharmacology course (N = 801) were queried about their top choices for antidepressant-treatment nonresponders: a minimal responder after 4 weeks of adequate SSRI treatment, a partial responder after 8 weeks of adequate SSRI therapy, a nonresponder after 8 weeks of adequate SSRI therapy, and a relapser on long-term SSRI maintenance therapy, Choices included raising the dose, augmenting or combining with another agent, switching to a second SSRI, or switching to a non-SSRI agent. Results: 432 (54%) of the surveys were returned. Raising the dose was the most frequently reported next-step strategy for a patient with minimal response after if weeks of adequate SSRI therapy, partial response after 8 weeks of adequate SSRI therapy, and relapse on long-term SSRI therapy. Switching to a non-SSRI agent was the most frequently chosen option for nonresponders to an adequate trial of SSRI therapy. Conclusion: Our findings suggest that clinicians select different next-step strategies when patients are nonresponders versus when patients are partial responders or relapsers.
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页码:403 / 408
页数:6
相关论文
共 16 条
[1]  
Byrne S, 1997, PSYCHIAT SERV, V48, P835
[2]   TREATMENT-RESISTANT DEPRESSION - A SURVEY OF PRACTICE HABITS OF CANADIAN PSYCHIATRISTS [J].
CHAIMOWITZ, GA ;
LINKS, PS ;
PADGETT, RW ;
CARR, AC .
CANADIAN JOURNAL OF PSYCHIATRY-REVUE CANADIENNE DE PSYCHIATRIE, 1991, 36 (05) :353-356
[3]   The Texas Medication Algorithm Project: Report of the Texas Consensus Conference Panel on medication treatment of major depressive disorder [J].
Crismon, ML ;
Trivedi, M ;
Pigott, TA ;
Rush, AJ ;
Hirschfeld, RMA ;
Kahn, DA ;
DeBattista, C ;
Nelson, JC ;
Nierenberg, AA ;
Sackeim, HA ;
Thase, ME .
JOURNAL OF CLINICAL PSYCHIATRY, 1999, 60 (03) :142-156
[4]  
FAVA M, 1995, J CLIN PSYCHIAT, V56, P52
[5]  
FAVA M, 1994, AM J PSYCHIAT, V151, P1372
[6]   Definition and epidemiology of treatment-resistant depression [J].
Fava, M ;
Davidson, KG .
PSYCHIATRIC CLINICS OF NORTH AMERICA, 1996, 19 (02) :179-&
[7]  
FAVA M, 1999, 152 ANN M AM PSYCH A, P186
[8]  
Fava Maurizio, 1996, P3
[9]   Strategies for augmentation of SSRI treatment: A survey of an academic psychopharmacology practice [J].
Mischoulon, D ;
Fava, M ;
Rosenbaum, JF .
HARVARD REVIEW OF PSYCHIATRY, 1999, 6 (06) :322-326
[10]  
NIERENBERG AA, 1991, J CLIN PSYCHIAT, V52, P383