Residual symptoms after remission of major depressive disorder with fluoxetine
and risk of relapse.
Author(s): Iovieno N, van Nieuwenhuizen A, Clain A, Baer L, Nierenberg AA.
Affiliation(s): Depression Clinical and Research Program at Massachusetts General Hospital,
Harvard Medical School, Boston, Massachusetts 02114, USA. niovieno@partners.org
Publication date & source: 2011, Depress Anxiety. , 28(2):137-44
BACKGROUND: Many patients with major depressive disorder (MDD) who achieve full
remission after antidepressant treatment still have residual depressive symptoms.
In this study, we assess the type and frequency of residual symptoms and their
relationship to subsequent depressive relapses after remission of major
depression with fluoxetine.
METHOD: Five hundred seventy-six patients with MDD were openly treated with
fluoxetine for 12 weeks. Those who responded underwent random assignment, under
double-blind conditions, to continue taking fluoxetine or to switch to placebo
for 52 weeks or until relapse. The presence of residual symptoms in patients who
achieved remission at the end of the acute phase (N=203) was assessed using the
28-item Hamilton Depression Rating Scale. Survival analysis was used to examine
the effect of residual symptoms on relapse in remitters.
RESULTS: More than 90% of patients who met criteria for remission had at least
one residual depressive symptom (median=4). The most common were sleep
disturbances (insomnia 48.2%, hypersomnia 35.9%) and anxiety (52.7%). The most
common individual symptom was middle insomnia (33.5%). No statistically or
clinically significant differences in baseline variables were found between
remitters with and without residual symptoms. The presence of residual symptoms,
the presence of residual insomnia and the global number of residual symptoms did
not predict relapse during the continuation phase of the study.
CONCLUSION: The great majority of patients with remission of MDD after treatment
with fluoxetine continue to experience selected residual depressive symptoms. The
presence of residual symptoms is not significantly associated with an increased
risk of relapse.
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