Fluoxetine-clonazepam cotherapy for anxious depression: an exploratory, post-hoc
analysis of a randomized, double blind study.
Author(s): Papakostas GI, Clain A, Ameral VE, Baer L, Brintz C, Smith WT, Londborg PD,
Glaudin V, Painter JR, Fava M.
Affiliation(s): Depression Clinical and Research Program at Massachusetts General Hospital,
Harvard Medical School, 15 Parkman Street, Boston, MA 02114, USA.
gpapakostas@partners.org
Publication date & source: 2010, Int Clin Psychopharmacol. , 25(1):17-21
Anxious depression, defined as major depressive disorder (MDD) accompanied by
high levels of anxiety, seems to be both common and difficult to treat, with
antidepressant monotherapy often yielding modest results. We sought to examine
the relative benefits of antidepressant-anxiolytic cotherapy versus
antidepressant monotherapy for patients with anxious depression versus without
anxious depression. We conducted a post-hoc analysis of an existing dataset
(N=80), from a 3-week, randomized, double-blind trial which demonstrated
cotherapy with fluoxetine and clonazepam to result in superior efficacy than
fluoxetine monotherapy in MDD. The present analysis involved examining whether
anxious depression status served as a predictor and moderator of symptom
improvement. Anxious depression status was not found to predict symptom
improvement, or serve as a moderator of clinical improvement to cotherapy versus
monotherapy. However, the advantage in remission rates in favor of cotherapy
versus monotherapy was, numerically, much larger for patients with anxious
depression (32.2%) than it was for patients without anxious MDD (9.7%). The
respective number needed to treat statistic for these two differences in response
rates were, approximately, one in three for patients with anxious depression
versus one in 10 for patients without anxious depression. The efficacy of
fluoxetine-clonazepam cotherapy compared with fluoxetine monotherapy was
numerically but not statistically enhanced for patients with anxious depression
than those without anxious depression.
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