BACKGROUND: Up to 50% of depressed older adults either do not adequately respond to or are unable to tolerate treatment with a serotonin-specific reuptake inhibitor. On the basis of previous experience with serotonin-norepinephrine reuptake inhibitors, we predicted at least a 50% response rate to open-label treatment with duloxetine in subjects who were resistant to treatment with the selective serotonin reuptake inhibitor (SSRI) escitalopram. METHOD: Community-dwelling subjects aged 65 years or older with current nonpsychotic major depressive disorder as established by the Structured Clinical Interview for DSM-IV received escitalopram under protocolized conditions between April 2004 and September 2006. Subjects who failed to meet response criteria or relapsed after achieving an initial response were subsequently switched to open treatment with duloxetine up to 120 mg/day. Side effects were assessed at every visit. RESULTS: Subjects (N = 40) switched to duloxetine had a mean (SD) age of 74.4 (7.0) years and a baseline (before escitalopram) 17-item Hamilton Rating Scale for Depression (HAM-D-17) score of 20.0 (3.5) and were predominantly female (65.0%) and white (82.5%). The mean (SD) maximum dose of duloxetine was 93.0 (27.8) mg/day. Subjects received this maximum dose for a median duration of 6.9 weeks. Fifty percent of subjects (N = 20) met criteria for full response, 17.5% (N = 7) were partial responders, and 32.5% (N = 13) did not respond. The median time to response was 12.0 weeks (95% CI = 8.4 to 14.6). Five of the subjects (12.5%) discontinued duloxetine because of intolerable side effects. DISCUSSION: These open-label data suggest that duloxetine at doses up to 120 mg/day is a well-tolerated and potentially effective treatment for older adults who fail to respond to an adequate trial of an SSRI. These results are preliminary, and future controlled studies are required to test the efficacy of rescue pharmaco-therapy with duloxetine. TRIAL REGISTRATION: clinicaltrials.gov Identifier: NCT00177671.
BACKGROUND: Up to 50% of depressed older adults either do not adequately respond to or are unable to tolerate treatment with a serotonin-specific reuptake inhibitor. On the basis of previous experience with serotonin-norepinephrine reuptake inhibitors, we predicted at least a 50% response rate to open-label treatment with duloxetine in subjects who were resistant to treatment with the selective serotonin reuptake inhibitor (SSRI) escitalopram. METHOD: Community-dwelling subjects aged 65 years or older with current nonpsychotic major depressive disorder as established by the Structured Clinical Interview for DSM-IV received escitalopram under protocolized conditions between April 2004 and September 2006. Subjects who failed to meet response criteria or relapsed after achieving an initial response were subsequently switched to open treatment with duloxetine up to 120 mg/day. Side effects were assessed at every visit. RESULTS: Subjects (N = 40) switched to duloxetine had a mean (SD) age of 74.4 (7.0) years and a baseline (before escitalopram) 17-item Hamilton Rating Scale for Depression (HAM-D-17) score of 20.0 (3.5) and were predominantly female (65.0%) and white (82.5%). The mean (SD) maximum dose of duloxetine was 93.0 (27.8) mg/day. Subjects received this maximum dose for a median duration of 6.9 weeks. Fifty percent of subjects (N = 20) met criteria for full response, 17.5% (N = 7) were partial responders, and 32.5% (N = 13) did not respond. The median time to response was 12.0 weeks (95% CI = 8.4 to 14.6). Five of the subjects (12.5%) discontinued duloxetine because of intolerable side effects. DISCUSSION: These open-label data suggest that duloxetine at doses up to 120 mg/day is a well-tolerated and potentially effective treatment for older adults who fail to respond to an adequate trial of an SSRI. These results are preliminary, and future controlled studies are required to test the efficacy of rescue pharmaco-therapy with duloxetine. TRIAL REGISTRATION: clinicaltrials.gov Identifier: NCT00177671.
Authors: M D Miller; C F Paradis; P R Houck; S Mazumdar; J A Stack; A H Rifai; B Mulsant; C F Reynolds Journal: Psychiatry Res Date: 1992-03 Impact factor: 3.222
Authors: J Craig Nelson; Madelaine M Wohlreich; Craig H Mallinckrodt; Michael J Detke; John G Watkin; John S Kennedy Journal: Am J Geriatr Psychiatry Date: 2005-03 Impact factor: 4.105
Authors: Ellen M Whyte; James Basinski; Panthea Farhi; Mary Amanda Dew; Amy Begley; Benoit H Mulsant; Charles F Reynolds Journal: J Clin Psychiatry Date: 2004-12 Impact factor: 4.384
Authors: Ramin Saghafi; Charlotte Brown; Meryl A Butters; Jill Cyranowski; Mary Amanda Dew; Ellen Frank; Ariel Gildengers; Jordan F Karp; Eric J Lenze; Francis Lotrich; Lynn Martire; Sati Mazumdar; Mark D Miller; Benoit H Mulsant; Elizabeth Weber; Ellen Whyte; Jennifer Morse; Jacqueline Stack; Patricia R Houck; Salem Bensasi; Charles F Reynolds Journal: Int J Geriatr Psychiatry Date: 2007-11 Impact factor: 3.485
Authors: Jordan F Karp; Bruce L Rollman; Charles F Reynolds; Jennifer Q Morse; Frank Lotrich; Sati Mazumdar; Natalia Morone; Debra K Weiner Journal: Pain Med Date: 2012-02-07 Impact factor: 3.750
Authors: Jordan F Karp; Debra K Weiner; Mary A Dew; Amy Begley; Mark D Miller; Charles F Reynolds Journal: Int J Geriatr Psychiatry Date: 2010-06 Impact factor: 3.485
Authors: Meera Sheffrin; Henry C Driscoll; Eric J Lenze; Benoit H Mulsant; Bruce G Pollock; Mark D Miller; Meryl A Butters; Mary Amanda Dew; Charles F Reynolds Journal: J Clin Psychiatry Date: 2009-02-10 Impact factor: 4.384
Authors: Christian Knöchel; Gilberto Alves; Benedikt Friedrichs; Barbara Schneider; Anna Schmidt-Rechau; Sofia Wenzler; Angelina Schneider; David Prvulovic; André F Carvalho; Viola Oertel-Knöchel Journal: Curr Neuropharmacol Date: 2015 Impact factor: 7.363
Authors: Eric J Lenze; Meera Sheffrin; Henry C Driscoll; Benoit H Mulsant; Bruce G Pollock; Mary Amanda Dew; Frank Lotrich; Bernie Devlin; Robert Bies; Charles F Reynolds Journal: Dialogues Clin Neurosci Date: 2008 Impact factor: 5.986
Authors: Nancy Kerner; Kristina D'Antonio; Gregory H Pelton; Elianny Salcedo; Jennifer Ferrar; Steven P Roose; Dp Devanand Journal: SAGE Open Med Date: 2014-05-08